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Ankylosing Spondylitis (AS)


Introduction

This research will give a closer look at AS, including the symptoms, treatments, causes, and exercises associated with it. Ankylosing spondylitis is a type of arthritis that mainly affects the spine, lower back, and sacroiliac joints.

Symptoms of this lifelong condition usually begin in early adulthood and include pain and stiffness in the lower back that worsens following rest or inactivity. As the disease progresses, the bones of the spine may fuse, causing a limited range of motion and decreased flexibility of the spine.

Besides the spine, ankylosing spondylitis may affect other joints, including the hips, knees, ankles, or shoulders. The disease may also be associated with systemic effects, such as fever, fatigue, and eye, or bowel inflammation.

AS is a type of arthritis. It mostly affects the lower part of the spine and the place where the spine joins to the hips, known as the sacroiliac joints.

AS can be difficult to diagnose, but this condition has a particular pattern of pain symptoms, and the changes are usually visible in X-ray and MRI scans.

Males are more likely rested Source to develop AS than females. The condition tends to be milder when it does occur in females, which also makes it harder to diagnose.

According to the Spondylitis Association of America, symptoms usually begin between the ages of 17 and 45 years. However, they can also develop in children and people who are much older.

While there is no cure for ankylosing spondylitis, Drug treatments and physical therapy can help relieve the symptoms.

Symptoms:

The most common early symptoms of AS are frequent pain and stiffness in the lower back and buttocks, which comes on gradually over the course of a few weeks or months. At first, discomfort may only be felt on one side or on alternate sides. The pain is usually dull and diffuse, rather than localized.

This pain and stiffness are usually worse in the mornings and during the night but may be improved by a warm shower or light exercise. Also, in the early stages of AS, there may be a mild fever, loss of appetite, and general discomfort. It is important to note that back pain from AS is inflammatory in nature and not mechanical.

The pain typically becomes persistent (chronic) and is felt on both sides, usually lasting for at least three months. Over the course of months or years, the stiffness and pain can spread up the spine and into the neck. Pain and tenderness spreading to the ribs, shoulder blades, hips, thighs, and heels is possible as well.

Note: AS can present differently at onset in some people. This tends to be the case in women more than men. Quoting Dr. Elaine Adams, “Women often present in a little more atypical fashion so it’s even harder to make the diagnosis in women.” For example, we have heard anecdotally from some women with AS that their symptoms started in the neck rather than in the lower back.

Other Symptoms

In a minority of individuals, pain does not start in the lower back or even the neck, but in a peripheral joint such as the hip, ankle, elbow, knee, heel, or shoulder. This pain is commonly caused by enthesitis, inflammation of the site where a ligament or tendon attaches to the bone.

The main symptoms of AS affect the spine and lower back, causing:

  • pain

  • stiffness

  • a loss of mobility

The pain is usually worse during rest and during the night, and it can interfere with restorative sleep. Moving around can generally improve pain levels.

However, the inflammation and pain are not confined to the spine. AS can also affect other parts of the body. These include the areas around other joints, such as the:

  • ribs

  • shoulders

  • knees

  • ankles, feet, and tendon insertions at the heel

  • top of the shin bone in the lower leg

  • Achilles tendon

Testing for Ankylosing Spondylitis

The tests used to diagnose ankylosing spondylitis include a physical examination, neurological exams, a medical history, blood tests, genetic testing, and imaging.

Physical examination: A physical examination of AS typically starts with a thorough review of your medical and family history.

Your medical history looks at whether your back pain is mechanical or inflammatory. According to the Spondylitis Association of America, mechanical back pain occurs due to physical changes in the back.

On the other hand, inflammatory back pain related to AS is persistent, lasting for more than three months, affects people under age 35, and worsens after periods of inactivity.2

Inflammatory back pain will improve with movement, exercise, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Once the healthcare provider has gotten information about your medical and family history, they will want to perform a thorough physical and neurological examination.

You will be asked to bend your back and hips in different directions during the physical exam to check for stiffness and pain. They might also push on some body areas to look for tender spots.

Since breathing difficulty is a sign of severe AS, the healthcare provider will also check your breathing.4 Breathing troubles in AS result from lung scarring due to inflammation, the upper body arching forward, and the chest wall stiffening.

Neurological examination: The neurological exam assesses sensory and motor functions, including reflexes and muscle strength.5 Your healthcare provider will also review your other neurological symptoms, such as nerve pain, numbness, tingling, muscle weakness or spasms, and bowel and bladder dysfunction.


Blood Tests : Blood work can look for signs of inflammation suggestive of AS. It is also done to rule out other conditions. Blood tests are not enough to confirm AS, but they help the healthcare provider make sense of your symptoms. There are no specific tests to confirm AS, but certain blood tests can check for inflammatory markers and rule out other conditions that cause similar symptoms.6

The following blood tests may be ordered if AS is suspected:

  • Erythrocyte sedimentation rate(ESR or sed rate): The ESR test detects inflammation in the body. The ESR rate is measured by how quickly red blood cells settle in a test tube.

  • C-reactive protein (CRP): CRP is a protein made by the liver. High levels of CRP are an indication of a condition that causes inflammation.

  • Complete blood count (CBC): The CBC test checks blood cell counts. High white blood cell counts, and low red blood cell counts indicate inflammation commonly linked to AS.

  • Rheumatoid factor (RF): RF is often associated with other autoimmune arthritis conditions like rheumatoid arthritis and lupus.7 The RF test is ordered to rule out these conditions when AS is suspected.

Confirming an Ankylosing Spondylitis Diagnosis

Your healthcare provider will rely on your physical and neurological exams, symptom history, imaging results, and blood work to diagnose AS.

According to a 2020 Rheumatology report, a healthcare provider can make a diagnosis of AS based on specific criteria, which include:10

  • Back symptoms: This includes back pain that has lasted three or months and started before age 40 that resolves with exercise and is worse in the morning and after periods of inactivity, back pain that alternates into buttock pain, and limited movement of the lower back

  • Finding relief with NSAIDs, which indicates back pain is the result of inflammation

  • Peripheral manifestations, such as arthritis in the arms, legs, and shoulders, dactylitis (swelling of the fingers and toes), and enthesitis (inflammation of the entheses—the sites where tendons and ligaments attach to bone)

  • Extra-musculoskeletal manifestations, such as uveitis, psoriasis (a chronic skin condition), and inflammatory bowel disease

  • Positive family history of AS

  • HLA-B27 positivity

  • High CRP and ESR levels

  • Evidence of sacroiliitis on imaging

We can understand with this graph


Treatments

There is currently no cure for AS, and the damage it causes is irreversible. However, some options can help relieve the symptoms and manage the progression.

These include:

  • physical therapies and exercises

  • certain drugs

  • surgery, in rare cases

People with a diagnosis of AS will need to see a specialist doctor known as a rheumatologist. They may need a number of visits, as the condition progresses slowly and consistent medical care allows better monitoring and treatment.

Two common approaches that help people manage AS are drugs, to reduce pain and inflammation, and physical therapy and exercises, to maintain movement and posture.

Doctors will only recommend surgery to correct severe deformity, such as excessive posture changes due to inflammation and ankylosing of the spine, or to replace a hip or other joint.

Doctors might also recommend certain diets, foods, or nutrients to help a person manage the symptoms of AS

Exercises

Physical therapy and exercises can help treat the symptoms and prevent or delay mobility limitations.

A physical therapist will be able to design a program that can help a person maintain good posture and motion in the joints.

This might consist of:

  • Daily exercises

  • Special training to address areas of involvement

  • Therapeutic exercises

Physical therapy exercises are known as strengthening exercises and range-of-motion exercises.

The Spondylitis Association of America says that an ideal exercise program will include the following four elements:

  • Stretching: This can improve flexibility and reduce muscle stiffness, swelling, and pain. It can also minimize the risk of joint fusion.

  • Cardiovascular exercises: These exercises, which include swimming and walking, can improve lung and heart function and reduce pain and fatigue.

  • Muscle exercises: This help strengthens the core and back muscles, which help support the spine. Having strong muscles can improve posture and movement, as well as reduce pain.

  • Balance training: This can help improve stability and reduce the risk of falls.

Certain drugs: These are the certain drugs which is taken by Ankylosing Spondylitis patients: Cosentyx, Humira, Simponi, Remicade, Enbrel, and Cimzia.



Therapeutic exercises: These exercises will really help to be in good posture. We can add Pranayama, Bhastrika, Deep Breathing, and Meditation.



How to do the exercises
Back stretches


1. Get down on your hands and knees on the floor.

2. Relax your head and allow it to droop.

3. Round your back up toward the ceiling until you feel a nice stretch in your upper, middle, and lower back.

4. Hold this stretch for as long as it feels comfortable, or about 15 to 30 seconds.

5. Return to the starting position with a flat back while you are on your hands and knees.

6. Let your back sway by pressing your stomach toward the floor. Lift your buttocks toward the ceiling.

7. Hold each position for 15 to 30 seconds. Repeat 2 to 4 times.


Conclusion: AS is a type of arthritis that affects the spine and lower back. Although there is currently no cure for AS, many treatments can help slow or stop the progression of the condition. Daily management, such as an exercise program, can help people control their symptoms.

Ankylosing spondylitis is an autoimmune disease that occurs when the immune system malfunctions and attacks healthy tissues—mainly the small bones of the spine. AS is an aggressive condition and early diagnosis is crucial to reducing spine complications, such as spinal fusion, fractures, and abnormal curvatures.

We will have many options for treating your condition, which can reduce symptoms and prevent disease progression. Taking your medications as prescribed and regular excises is slowing down the disease’s effects on you, keeping you moving and independent, and maintaining a good quality of life.

In addition to following your treatment plan, you should see a rheumatologist regularly. And make sure you speak up if your treatment plan isn’t managing your symptoms adequately.



Hope you got a good idea about ankylosing spondylitis. Don’t panic. It is not curable but well-treatable. Thank you for reading.

Happy Testing!!

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