Ankylosing Spondylitis (AS) is not due to “wear and tear”. This disease typically results in inflammation of the joints of the spine. As these joints become damaged, the spine stiffens and back becomes less flexible. In some patients, hips and knees may also be affected. AS usually affects teenagers and young adults, less than 40 years old.
Early symptoms include persistent pain and stiffness in the lower back or neck for several months. The pain and stiffness is usually worse in the morning, often making it difficult for you to get out of bed. The pain may sometimes wake you up at night. This is quite different from back strain which is better after rest. You may also experience pain and early morning stiffness in other joints, the back of your ankle(s) and/or sole(s). Some may also experience severe pain, redness of the eyes and blurred vision as part of AS.
There is no proven cause for AS but there are various theories involving genetic and environmental factors. A disorder in the immune system or an over-reaction to an unknown trigger such as a virus infection can set off the condition. In normal circumstances, your body’s immune system helps to fight infection. However in AS, your immune system mistakenly sends signals to and attacks the lining of your joints, resulting in inflammation – hence the term “autoimmune disease”. There is a strong linkage to a gene called HLA B-27. This gene is present in 90% of patients with AS.
As with many other chronic diseases, while there is no cure as yet for AS, it is a treatable condition and can be effectively managed with medications and other strategies. It is advised that you consult your doctor for an individually tailored treatment plan as not all medications may be suitable for you.
1. Physiotherapy is the cornerstone of the treatment of AS.
Your doctor would recommend you to a physiotherapist who would teach you specific exercise routines for AS to maintain your range of motion, achieve posture control, strengthen muscles, and improve balance. You would be advised to follow the exercises prescribed at home. Non-spinal loading exercises such as swimming are very useful for people with AS.
a. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the joint inflammation, and thereby improve the pain and swelling that you might experience.
b. Disease-modifying anti-rheumatic drugs (DMARDs) e.g. sulfasalazine are sometimes prescribed to slow the progression of AS and protect the joints from further irreversible damage.
c. Biologic agents and small molecules are prescribed for patients who have severe disease and have failed other treatments including NSAIDs. Whilst effective, they can be more expensive. Not everyone with AS would need or are suitable for such medications.
Consulting a doctor early for an assessment if you have prolonged back pain and stiffness or joint inflammation, that is worse especially in the morning, may help prevent joint deformities and disabilities. An active lifestyle helps to maintain the mobility of the spine. Smoking cessation prevents spinal and lung complications associated with AS.