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Ankylosing Spondylitis

Ankylosing Spondylitis Cause/Diagnosis:

There is no certain know cause but most patients who present with Ankylosing Spondylitis have a genetic marker that can be seen in a simple blood test called HLA-B27. This condition can be found in anyone but it is seen in men aged 17-45 more often and does occur earlier than other rheumatic diseases. It is important to keep in mind that the patient does not have to have the HLA-B27 in order to be diagnosed with Ankylosing Spondylitis. The HLA-B27 marker is very commonly seen in Caucasian population and it is important to keep in mind that healthy individuals do carry this marker. It is probable that there are other gene markers involved as well along with environmental factors and there has been a proposed possible intestinal bacteria link that makes certain people more susceptible to acquiring Ankylosing Spondylitis.

Other blood tests than can be done include: C-Reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR) which do increase in inflammatory state and Ankylosing Spondylitis has a role to play in this.

Another way to identify Ankylosing Spondylitis is by completing an x-ray of sacroiliac joints (SI joints) which would reveal sacroiliitis (inflammatory change in the SI joint). To obtain an earlier diagnosis it would be ideal to complete a MRI or CT scan in order to gain insight into disease process where an x-ray of the sacroiliac joint can be read as normal if done in the early disease development state.

Ankylosing Spondylitis Symptoms:

Like other forms of arthritis this can cause pain as well as inflammation and the intensity/severity of the disease varies between individuals. The spine is stiff (especially the lower back and buttocks) and the back posture may become hunched back because the vertebral spine is not able to move to the degree it used to due to the vertebra joints being fused together. The discomfort comes on gradually over timeframe of weeks or months and can be felt either on one side or both sides and eventually becomes constant on both sides and can last for at least three months and as time goes by the discomfort can be noticed in other joints such as hips, ribs or neck. In the morning as well as night pain tends to increase. Each patient is affected in various ways for example for some patients the pain comes and goes and others may have it all the time. It is important to keep in mind that with inflammation (Crohn’s disease, Ulcerative Colitis) a person can be more lethargic as well. Other less common symptoms that can develop include inflammation of the bowel as well as inflammation of the eyes (iritis or uveitis) where the eye may feel pain, sensitivity to light and increased discharge of tears.

Ankylosing Spondylitis Treatment:

It is important to follow up with your rheumatologist on an annual basis even if a patient has mild form of Ankylosing Spondylitis in order to detect and manage any complications. If this is not treated there is an increased risk of developing chronic pain and deformities. Unlike other types of arthritis Ankylosing Spondylitis symptoms can decrease and disappear over time as the patient ages but again that is not the case for everyone. In times of severe pain it is beneficial to rest, use heat or ice intermittently. It is also advisable to adjust the amount of activity as well as the type of activity performed. NSAIDs (non steroidal anti-inflammatory drugs) helps alleviate the pain and stiffness and if this is not beneficial the next step is to prescribe DMARDs (anti rheumatic medication) and there are also drugs that fall into biologics category also called TNF Blockers.

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