Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory rheumatic disease, primarily affecting the axial skeleton ( sacroiliac joints & spine ) but also affects peripheral joints, enthesis, eyes and in very rare cases it may also affect heart and lungs.

The word “ankylosis” means fusion, and the word “spondy” is related to vertebrae and “itis” means inflammation. So in short ankylosing spondylitis is a condition associated with inflammation of the spine which if untreated may eventually lead to fusion of vertebrae.

This type of arthritis which involve joints of spine with or without peripheral joint involvement are categorized under the term spondyloarthropathies.

Ankylosing Spondylitis treatment in Pune

The spondyloarthropathy family consists of following disorders.

  • Ankylosing spondylitis

  • Psoriatic arthritis or arthritis associated with psoriasis

  • Reactive arthritis

  • Spondyloarthritis associated with crohn’s disease & or ulcerative colitis.

  • Juvenile onset spondyloarthritis

 These are also known as seronegative spondyloarthropathies. The word seronegative indicates that these diseases are negative for rheumatoid factor hence seronegative.

A typical patient is young aged between 18 – 30 yrs old.

Male are affected more often than females ( 3:1ratio )

HLA-B27 is the most common genetic component in patients with ankylosing spondylitis. Which means if the person has signs and symptoms of the disease and the person is positive for HLA-B27 gene then he or she may have spondylitis.

However, there are few specifications here.

  1. If you are only HLA-B27 positive this doesn’t  mean you have the disease as HLA-B27 can be positive in upto 8% of normal population, but only 1-6% of adults who are HLA-B27 positive suffer from ankylosing spondylitis or any other type of spondyloarthropathy.

  2. If you are HLA-b27 negative this doesn’t mean you do not have the disease or will never have the disease. Diagnosis of ankylosing spondylitis relies on associated signs and symptoms like inflammatory low back pain and or buttock pain, uveitis, inflammation in other joints, tendinitis etc.

The triggering event for the onset of symptoms may sometimes be a gastrointestinal infection or a urogenital infection.

Ankylosing Spondylitis treatment in Pune

Common symptoms :

  1. Sudden onset of low back pain or pain in buttock region which may shift to either side. The pain may be worse in the second half of the night and in the morning or after periods of inactivity. The pain may also be accompanied by stiffness in the low back region.

  2. NSAID’S ( Non steroidal anti-inflammatory drugs ) may provide significant relief in symptoms.

  3. Peripheral joint arthritis : joints of limbs may also be involved in some cases. Such cases are specifically referred as ankylosing spondylitis with peripheral arthritis. Lower limb joints are more commonly affected but there may also be arthritis of hand joints. Peripheral joint involvement is usually asymmetrical which means if knee joint is affected on right side ankle or hip joint may be affected on left side or vice versa.

  4. Heel pain : there may be persistant heel pain or a history of heel pain in the past.

  5. Dactylitis : Dactylos ( Greek ) means finger. Dactylitis is inflammation of the entire digit ( a finger or a toe ) and is painful.

  1. Constitutional symptoms like low grade fever or feverish feeling in absence of fever, fatigue, weakness and weight loss may be present.

  2. This disease may sometimes affect other organs such as eyes characterized by pain and redness of either or both eyes with blurring of vision.

  3. There may also be involvement of intestinal walls giving rise to inflammationof intestinal walls leading to inflammatory bowel diseases such as crohn’s disease or ulcerative colitis.

  4. Due to long term inflammation in the vertebral they fuse together resulting in a stiff spine and an appearance of stooped posture.

 

Diagnosis of ankylosing spondylitis:

Diagnosis of ankylosing spondylitis is based on clinical signs and symptoms, Xray , MRI findings and blood tests.

 

Treatment :

The goal of treatment in ankylosing spondylitis is

  1. Patient education and counseling.

  2. Relief of pain with NSAIDS.

  3. Maintaining good mobility and functional status with physiotherapy and exercises.

  4. Disease modification or controlling disease activity.

  5. Prevention of joint damage and deformities.

  6. Corrective surgeries if required.

 

  1. NSAIDS:

Non steroidal anti-inflammatory drugs(NSAIDS) or more popularly known as pain killers are effective in relieving pain and stiffness in patients with ankylosing spondylitis both in short term and long term continuous therapy. Recent researches have shown that continuous treatment with these agents resulted in reduction in radiographic progression of disease which means they also have disease modifying role in ankylosing spondilitis. These agents form baseline therapy and are always included in the management of AS.

However as we all know that long term use of these drugs is associated with stomach ulcers and kidney disease these drugs should be taken only under supervision and as prescribed by your rheumatologist along with regular blood test.

 

  1. DMARD’s (Disease Modifying Anti Rheumatic Drugs):

  1. Sulfasalazine : some patients experience a significant improvement with prolonged use of sulfasalazine (2 -3 gm/day ). Sulfasalazine has been proven to be effective in peripheral arthritis.

  2. Methotrexate : methotrexate has a been proven to be effective in peripheral arthritis associated with ankylosing spondylitis.

 

  1. Biologics :

Biologics used to treat ankylosing spondylitis include anti TNF (anti tumor necrosis factor) agents like

  • Adalimumab

  • Etanercept

  • Infliximab

If NSAIDs and DMARDS are not controlling your symptoms then you may be prescribed biologics or anti- tnf agents. As these drugs are very expensive their use is limited to only those patients who are not responding to NSAIDS and DMARDs.

Anti tumor necrosis factor agents have been proven significantly to reduce spinal pain and stiffness and to increase spinal movement and patient function.

These drugs are administered by injection into your skin( subcutaneously ) or though an intravenous injection. As biologic drugs target immune cells there is always a risk of getting infection. Hence special care has to be taken while on these medicines.

  1. Adjunctive treatment: 

Bisphosphonates, calcium and vitamin-D may improve bone density.

 

 

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