What is it?
Ankylosing spondylitis, or AD, is the typical example of the group of arthritis that primarily affects the spine or back, known as spondyloarthropathies, which include, in addition to this, psoriatic arthritis, reactive arthritis, undifferentiated spondyloarthropathies, Crhon-associated arthritis. and ulcerative colitis, SAPHO syndrome and certain subclasses of juvenile arthritis. Spondyl refers to the spine, it is means inflammation . Ankylosing is a term that means rigid.
In AD, the joints and ligaments that normally allow the spine to move and flex become inflamed. The inflammation produces pain and stiffness that usually begins in the lower back. Over time, the disease can progress to the upper spine, chest and neck. As a result, joints and bones (vertebrae) can fuse, causing the spine to become rigid and inflexible. Other joints, such as the hips, shoulders, knees or ankles can also become inflamed.
Ankylosing spondylitis can become a chronic (long-term) disease. The severity of symptoms and disability vary from person to person. Early diagnosis and appropriate treatment can help control the pain and stiffness associated with ES and reduce or prevent further deformity.
The symptoms of AD occur more frequently in young men between sixteen and thirty years. The disease is less common in women, who have milder symptoms that are more difficult to diagnose. About 5% of people with AD develop it in childhood, children are more susceptible to presenting it than girls. When children have ankylosing spondylitis, the symptoms usually start in the hips, knees, heels or big toe and then progress to the spine.
More than 500,000 Indians have ankylosing spondylitis.Almost everyone who has EA has inherited the HLA-B27 gene.
What is the cause?
The cause of ankylosing spondylitis is unknown, but genes and inheritance play a role in its etiology. Scientists have discovered a gene called HLA-B27 that is found in more than 90% of people with AD. It is a member of the family of genes associated with the immune system, which defends the body against infections.
Having the HLA-B27 gene does not necessarily mean that you will have AE. In fact, a person carrying the HLA-B27 gene who does not have relatives with AD has only 2% risk of developing this disease. For people with the HLA-B27 gene who have a father or sibling with AD, the risk of suffering from the disease is only 20%. Therefore, factors other than HLA-B27 play a role in the development of the disease.
Recent studies have focused on several bacteria that could influence the development of AD, but a defined or specific infectious agent has not yet been detected.
What are the symptoms?
Inflammation of AD usually begins around the sacroiliac junction, where the low spine attaches to the pelvis.
The most common early symptoms of AD are chronic pain and stiffness of the lower back and hips. This discomfort usually develops slowly for several weeks or months. In contrast to back pain of different origin, the pain associated with AD is worse during periods of rest or inactivity. People with AD often wake up in the middle of the night with back pain and feel very stiff in the morning. Typically, the symptoms are lessened with movement and exercise.
Over time, pain and stiffness can progress to the superior spine and even the cavity of the ribs and neck. Ultimately, inflammation can cause the sacral iliac bones and vertebrae to fuse or grow together. When bones are fused, the spine and neck lose their normal flexibility and become stiff. The chest cavity can also melt, which can limit the normal expansion of the chest and make breathing difficult. Inflammation and pain can also be seen in the hips, shoulders, knees, or ankles, which can limit movement. The heels can be compromised, so you feel uncomfortable standing or walking on hard surfaces.
Ankylosing spondylitis is a systemic disease, which means it can affect other organs of the body in some people. The disease can cause fever, loss of appetite, fatigue and inflammation in organs such as the lungs, heart and eyes.
Ocular inflammation (called iritis) occurs in a quarter of people with AD. Iritis causes redness and pain in the eye that gets worse when you look in bright light. This is a serious disorder that requires immediate medical attention from an ophthalmologist (eye specialist).
The symptoms of AD can be similar to those that occur in other diseases such as psoriasis, inflammatory bowel disease, or Reiter's syndrome (reactive arthritis). An appropriate diagnosis is important in order to be prescribed the appropriate treatment.
How is it diagnosed?
The doctors base the diagnosis of AD on the symptoms, physical examination and X-rays that show that the iliac sacral junction in the posterior part of the pelvis is affected. If X-rays are questionable, the most sensitive CAT scan test can be done (ultrasonic scanning that sends X-rays through the body from various angles). The doctor may also order blood tests to check for the presence of the HLA-B27 gene . About 90% of people with ankylosing spondylitis are positive for this gene.
The treatment focuses on reducing pain and stiffness, to prevent deformations and help you to continue your normal activities . Below are the main areas of treatment and control of ankylosing spondylitis.
Medicines are an essential and continuous part of the treatment of AD.
Nonsteroidal anti-inflammatory drugs ( NSAIDs ) help relieve pain and stiffness, which allows you to exercise, maintain good posture, and continue your daily activities. Examples of NSAIDs that can be used to treat ankylosing spondylitis include indomethacin, ibuprofen and naproxen.
Disease-modifying antirheumatic drugs ( DMARDs ) such as sulfasalazine, and methotrexate reduce inflammation and can also slow or stop the progression of the disease.
Researchers are exploring the use of pamidronate ( Aredia ) -a drug approved by the FDA (Food and Drug Administration) to treat bone diseases. Thirteen men and two women with severe AD were given 30 mg. in an initial intravenous dose followed by five monthly intravenous doses of 60 mg. After six months of treatment, bone loss decreased by 75%.
To combat the pain, stiffness and inflammation of AD, the FDA has approved the drug celecoxib ( Celebrex ) for people with AD. It is dosed in a single dose of 200 mg. a day, or two of 100 mg. If it does not work in six weeks, 400 mg can be tested. newspapers for another six weeks. If it still does not improve, the Celebrex will probably not work for you.
The TNF inhibitors biological agents etanercept, infliximab, adalimumab and golimumab are also approved for the treatment and symptoms of AD, as well as secukinumab ( Cosentyx ), another type of biological directed against interleukin 17A (IL-17A), involved in the inflammatory process.
Maintaining good posture
Whether you are asleep, sitting or standing, maintaining an appropriate posture is important to avoid fusing the joints in undesirable positions.
Sleep on a firm mattress . Try to sleep on your back with a thin pillow or one that only supports the hollow of the neck. Keep your legs straight instead of falling asleep in a fetal position. If it is difficult or uncomfortable to sleep this way, talk to your therapist about other ways to position your body for comfort.
When walking or sitting, keep your back as straight as possible with your shoulders back and your head erect. You can test if your position is correct by standing against a wall your heels, glutes, shoulders and head should touch the wall at the same time.
In general, the use of corsets and orthotics does not help in the treatment of AD. It is better to try to maintain a good posture by following the aforementioned suggestions and exercising properly.
Regular exercise is an important part of EE management. A physiotherapist with experience in the treatment of arthritis can design an exercise program that meets your needs.
Exercises that strengthen the back and neck will help you maintain or improve your posture. Aerobic and deep breathing exercises will help you keep your chest and chest flexible. Swimming is a good form of exercise because it helps maintain flexibility in the back, neck, shoulders and hips.
If you feel too stiff and sore for exercise, try taking a hot bath or shower to loosen your joints and muscles. Start the exercises slowly and plan to do them when you are less tired and have less pain.
If any of your joints have merged or you already have limited mobility, you may find that self-help itemsmake everyday tasks easier for you. For example, shoes with long handles and socks can help if your back or hips do not flex easily. An occupational therapist can advise you on either auxiliary devices or special devices.
When driving, always wear a seat belt with a shoulder strap and adjust the seat head to support the neck. If the stiffness of your neck or back makes it difficult for you to back up, try adapting your car with super-wide mirrors.
If your spine is fused, you may get hurt easily. To help prevent injury, avoid activities that could cause a fall or sudden impact. Talk with your doctor or therapist about how to avoid harm and improve your functional capacity.
If you smoke , one of the best things you can do for yourself is to stop smoking . EA can affect the lungs and chest, making breathing difficult. Smoking worsens any lung problem you may have from AD.
The surgical joint replacement allows many people back to use the joints that have been affected by EA. Hip, knee and shoulder replacements are becoming very successful in people with AD.
If your spine has bent severely that you cannot see in front of you, surgery may help straighten your spine. Because surgery is complex, it is only performed in a few highly specialized medical centers. If necessary, your doctor can refer you to one of them.
Most forms of arthritis do not limit your ability to enjoy sex and romance . Sometimes, however, some problems such as pain and movement restrictions - especially of the hip - can interfere with sexual pleasure. Certain planning can be useful.
Effective communication is one of the most important aspects of a healthy sexual relationship. If you and your partner can openly discuss your needs, you can overcome almost any difficulty.
Think about what you do to feel more comfortable when the pain bothers you when you are lying in bed. These changes of position can be adapted to make your relationship more comfortable and pleasurable for both. You might consider planning the moment of intimacy when you are more rested.
Pregnancy in women with AD usually does not involve any special problems for the mother or the baby. However, some medications can be harmful to the fetus. If you are pregnant or plan to be pregnant, you should discuss the use of medications with your doctor. For more information on the management of sexuality and ankylosing spondylitis, ask for a copy of the Guide to Intimacy , from the Arthritis Foundation.
Most people with AD can continue a productive life and an active work schedule. Whether you work inside or outside the home, the following suggestions can help you.
If your current job forces you to stoop or cause excessive strain on your back, perhaps you should consider a job change. Contact a vocational rehabilitation agency in your area for guidance . The agency can also help you if your experience, education or training makes it difficult for you to change jobs. For ideas related to office work and other work activities read Protect your joints to see some tips.