HYDERABAD : Ankylosing spondylitis (AS) is a lifelong (chronic) form of arthritis that mainly affects the spine. The sacroiliac joints that connect the base of the spine (sacrum) to the pelvis are commonly inflamed in AS, as are the joints in the neck, back, hips and shoulders. Because the lower back is typically the main site of inflammation, a person suffering from AS usually experiences lower back pain. As a result of the inflammation in the spine, new bone may grow around the joints. For some people, this can lead to permanent stiffness in the back or neck. AS can also affect other parts of the body, such as the eyes, skin, bowel and lungs.
Symptoms of AS most commonly begin between the ages of 20 and 30 years. In fact, approximately 80% of patients with AS experience symptoms before their thirtieth birthday while only 5% present with symptoms after they have crossed the age of 45 years. AS occurs twice as frequently in men than in women. We are yet to fully understand what causes or triggers AS. People are more likely to develop AS if there is a family history of the condition. Many environmental factors and genes can contribute to AS; for example, a person with the HLA-B27 gene is more likely to have this form of arthritis than someone without the gene and yet, not everyone with the gene develops AS. Smoking is the single most important ‘modifiable’ risk factor for developing more severe AS.
This condition is diagnosed based on symptoms such as back pain that gradually becomes worse over several months and stiffness that makes it uncomfortable to lie in bed after waking up. A doctor may also ask for imaging tests; until recently, looking for specific changes on an X-ray was the only way to confidently confirm AS but today, an MRI scan of the sacroiliac joints can confirm the diagnosis at an earlier stage. Blood tests including the HLA B27 gene test may be prescribed to rule out other conditions and confirm the diagnosis.There is no meaningful way to prevent AS, because its specific cause is unknown. The best course of action is to prevent the disorder from becoming worse by carefully following the prescribed treatment plan and staying active.
Treatment for AS usually involves:
l Physiotherapy and regular exercise help to relieve pain, keep the spine flexible and improve posture
l Medicines that help to relieve pain, prevent complications and are prescribed based on whether there are additional symptoms such as axial arthritis (affecting the spine and/or sacroiliac joints), peripheral arthritis (affecting the hands, feet, elbows, knees or other joints), or enthesitis (inflammation at the location where tendons and ligaments meet the bone). They include:
l Non-steroidal anti-inflammatory drugs (NSAIDs)
l Corticosteroid medicines or injections
l Disease-modifying anti-rheumatic drugs (DMARDs)
l Biological DMARDs.
Cigarette smoking, or other health problems increase the loss of function from the disorder, so living a healthy lifestyle may help in preventing ankylosing spondylitis from becoming more serious. A physically strenuous job may also cause the disease to become worse. The most important thing is to visit the rheumatologist as early as possible.
The author is consultant rheumatologist,Yashoda Hospital,Secunderabad
