What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is a type of chronic inflammatory arthritis that primarily affects the spine and the sacroiliac (SI) joints. It can cause progressive fusion of the vertebra leading to stiffness and immobility in the spine. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.
Who might have ankylosing spondylitis (AS)?
Anyone can get AS, although it affects more men than women. Symptoms usually appear in people between the ages of 17 and 45. Ankylosing spondylitis has a genetic link and may run in families.
Clinical Feature
1. Low back pain and stiffness, which is often worse in the morning and improves with mobility.
2. Progressive loss of spinal mobility, leading to rigid spine.
3. Inflammation of the sacroiliac joints, causing pain and stiffness in the lower back and hips.
4. Enthesitis, which is inflammation at the site where tendons or ligaments attach to bone.
5. Fatigue and reduced physical activity levels.
6. Uveitis, which is inflammation of the middle layer of the eye.
7. Psoriasis, a skin condition.
Causes
Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.
Diagnosis
1. History
2. Physical Examination
3. Imaging scans: Magnetic resonance imaging (MRI) scans can detect spine problems earlier than traditional X-rays.
4. Blood tests: Blood tests can check for the presence of the HLA-B27 gene.
Complication
1. Fused vertebrae (ankylosis).
2. Kyphosis (forward curvature of the spine).
3. Osteoporosis.
4. Painful eye inflammation (iritis or uveitis) and sensitivity to light (photophobia).
5. Heart disease, including aortitis, arrhythmia and cardiomyopathy.
6. Chest pain that affects breathing.
7. Jaw inflammation.
8. Cauda equina syndrome (nerve scarring and inflammation)
Management
Medical management:
Drugs:
1. Non steroidal anti inflammatory drugs (NSAID’s) : Ibuprofen, Naproxen.
2. Disease modifying anti rheumatic drugs (DMARD’s): Sulfasalazine.
3. Corticosteroid.
Surgery: A small number of people with ankylosing spondylitis may need surgery. Joint replacement surgery implants an artificial joint. Kyphoplasty corrects a curved spine.
Physiotherapy Management
1. Stretching exercises: Gentle stretching exercises can help maintain spinal mobility and prevent stiffness.
2. Strengthening exercises: Targeted strengthening exercises for the muscles supporting the spine can help improve posture and reduce pain.
3. Aerobic exercises: Low impact aerobic exercises like cycling, swimming or water aerobics can improve cardiovascular fitness and overall health.
4. Heat therapy: Applying heat to the affected joints can relieve pain and stiffness.
5. Posture improvement: Proper posture can help reduce pain and prevent further spinal fusion. A physiotherapist can teach the patient proper posture and body mechanics.
6. Breathing and relaxation exercises to reduce stress and anxiety.
7. Taping, bracing and assistive devices to support the joints and improve mobility.
8. TENS.
9. UST
Dr. Md. Shafiullah Pradhan
Physiotherapy, Disability and Rehabilitation specialist
Associate Professor (IIHS), Consultant at DPRC.
12/1 Ring Road, Shaymoli, Dhaka.
Phone: 01997702001.
