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Ankylosing Spondylitis

Rheumatology

Ankylosing Spondylitis (AS) is a chronic inflammatory condition caused by an autoimmune system dysfunction, primarily affecting the spine and sacroiliac joints, leading to arthritis and stiffness. Ankylosing spondylitis mainly affects young men, with most cases occurring in individuals between twenty and thirty.

Symptoms

Lower Back Pain and Stiffness: Particularly noticeable in the morning or after prolonged sitting.
Spinal Stiffness: This may lead to kyphosis or spinal deformities.
Other Joint Pain: In the hips, shoulders, and knees.
Systemic Symptoms: Fatigue, fever, and weight loss.

auses and Factors

Causes

The exact causes of ankylosing spondylitis are not fully understood, but it is believed to involve a combination of genetic and environmental factors.
The presence of the HLA-B27 gene significantly increases the risk of developing the condition, with approximately 90% of AS patients carrying this gene.

Risk Factors

Gender: Ankylosing spondylitis primarily affects young males.
Age: Most patients develop the condition between the ages of 20 and 30, with onset after age 50 being less common. Clinically, there are also cases of adolescents presenting with situations similar to ankylosing spondylitis.
Family History: Increased risk for those with a history of the disease.

Diagnosis

Traditional Diagnostic Criteria:

New York Criteria (Revised 1984): Required X-ray evidence of sacroiliac joint sclerosis made it challenging to diagnose early cases of ankylosing spondylitis.

Current Diagnostic Criteria:

The modern approach integrates multiple methods to enhance diagnostic accuracy and facilitate early detection of ankylosing spondylitis:

Clinical Diagnosis:
- Occiput-to-Wall Distance Test: Measures the distance between the back of the patient's head (occiput) and the wall when standing straight.
- Lumbar Flexibility Test: Assesses the difference in distance between two marked points on the spine in standing and bending forward positions.
Imaging Tests:
- X-rays and MRI detect inflammation and fibrosis in the sacroiliac joints and spine.
Blood Tests:
- Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): Measure the level of inflammation in the body.
Genetic Testing:
- HLA-B27 Gene Test: About 90% of ankylosing spondylitis patients carry this gene.
Patient Questionnaire:
- BASDAI Questionnaire: Evaluate the patient's assessment of symptoms and disease severity.

Treatments

The treatment of Ankylosing Spondylitis primarily involves medication and physical therapy.

Medication

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Effectiveness: Relieves inflammation and reduces pain.
Side Effects: Traditional NSAIDs can cause gastrointestinal issues; newer NSAIDs have a lesser impact on the stomach.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Common Medication: Sulfasalazine.
Effectiveness: Particularly effective for peripheral joint inflammation (e.g., shoulders, hands, and feet) but has limited effect on axial joints (e.g., cervical spine, thoracic spine, lumbar spine, and sacroiliac joints).
Side Effects: These can cause various side effects, including gastrointestinal disturbances and allergic reactions.

Biologics

Target: Anti-Tumour Necrosis Factor (Anti-TNF) drugs.
Effectiveness: Effectively controls inflammation in the axial spine and peripheral joints.
Administration: Injection.
Side Effects: This may increase the risk of infections and other side effects.

Physiotherapy

Objective: To maintain joint flexibility and reduce stiffness.
Exercise Recommendations: Swimming and stretching exercises are encouraged to enhance flexibility and overall physical function.

Doctors tailor medication prescriptions based on individual patient conditions, often combining different drugs to balance efficacy and side effects for optimal treatment outcomes. Regular follow-up with healthcare providers is essential to monitor disease progression and adjust treatment plans as necessary. These treatment strategies significantly improve disease management and quality of life for patients with ankylosing spondylitis.