Ankylosing spondylitis is an inflammatory disease that involves the fusion of certain vertebrae that form the spine, a process that leads to stiffening of the spine and the development of a hunchbacked posture, as well as respiratory difficulties, especially if the vertebrae in the rib cage are affected. According to statistics, men are more likely to develop this condition. Even if it is not curable, certain medications and physiotherapy help to relieve the symptoms of ankylosing spondylitis and can slow its progression.
As we age, the spine, which bears much of the effort we make every day, undergoes transformations. Mainly, it loses its elasticity, it can no longer absorb the shocks felt, the intervertebral discs suffer various injuries (they lose water, break or deform).
Spondylitis (or spondyloarthritis, not to be confused with spondylosis) is a form of arthritis, a progressive chronic disease that manifests in the spine (resulting in inflammation) and in the peripheral joints. Inflammation can be traumatic, infectious or tuberculous. When spondylitis affects the spine, the vertebrae fuse, leading to stiffness and limited mobility.
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Causes of Ankylosing Spondylitis
Ankylosing spondylitis may be based on a genetic component, but the cause of this condition is not yet well determined. According to experts, people who have the HLA-B27 gene have a higher risk of developing this condition. This is because the gene causes the immune system to respond excessively to the attack of certain bacteria in the body, which causes the inflammation that underlies the symptoms of ankylosing spondylitis.
A person is more likely to suffer from spondylitis if they have a family history of complications or other similar problems. Some elements that are associated with spondylitis include:
- Previous inflammation in the joints and tissues, which can exacerbate similar problems caused by spondylitis
- Lack of exercise
- Obesity
- Smoking or excessive alcohol use
- Back problems such as degenerative disc disease or spinal stenosis
- Hereditary factors and spondylitis
Spondylitis is considered a hereditary disease, although environmental factors are also involved. Most people with HLA-B27 antigen do not develop spondylitis. It is known that white men are affected four times more often than women. The onset usually occurs between the ages of 15 and 45.
Because genetics play a role, having a family member diagnosed with spondylitis or a history of back pain or other common problems can increase the risk of developing spondylitis.
Spondylitis is thought to be genetically inherited, and most people with this condition (almost 90%) are born with a gene known as the HLA-B27 gene. Blood tests were developed to detect the HLA-B27 gene marker and helped to understand the relationship between HLA-B27 and spondylitis. The HLA-B27 gene appears only to increase the tendency to develop ankylosing spondylitis, while other factors, such as the environment, are required for the disease to occur or manifest. For example, while 7% of the United States population has the HLA-B27 gene, only 1% of the population actually has ankylosing spondylitis. In northern Scandinavia (Lapland), 1.8% of the population has ankylosing spondylitis, while 24% of the general population has the HLA-B27 gene. Even among individuals whose HLA-B27 blood test is positive, the risk of developing spondylitis still appears to be inherited. In HLA-B27 positive individuals who have relatives who have this disease, the risk of developing spondylitis is 12% (six times higher than for those whose relatives do not have spondylitis).
Symptoms of Ankylosing Spondylitis
The early symptoms of ankylosing spondylitis usually appear around the age of 45 and consist of pain and stiffness in the lower back and thighs, especially in the morning or after a period of rest or sitting. Sore throat and fatigue are also common symptoms of ankylosing spondylitis. Other manifestations of ankylosing spondylitis may be:
- Formation of an unsightly curve in the spine
- Pain or numbness in the shoulders, thighs, hands or even the Achilles tendon
- Swelling of the joints
- Difficulty breathing
- Pain during sneezing or coughing
- Gastrointestinal disorders (diarrhea, fecal blood, abdominal cramps)
- Depression and / or anxiety
- Eye inflammation (uveitis), blurred vision, sensitivity to light
- Cardiac arrhythmia
Ankylosing spondylitis treatment
Therapeutic management of ankylosing spondylitis includes general measures and specific drug treatment.
The goals of treatment are:
- reduction of inflammation and pain;
- maintaining mobility and joint function;
- prevention of the appearance of ankylosis at the level of the spine (slowing down the progression of radiological lesions and the appearance of ankylosis);
- minimizing extra-articular manifestations and peripheral damage;
- prevention of complications in the spine.
Drug treatment
It contains the following therapeutic solutions:
- NSAIDs;
- Analgesics;
- DMARDs;
- Corticosteroids;
- Biological anti-TNFα agents.
Non-pharmacological treatment
Education includes general principles such as:
– smoking avoidance (which contributes to pulmonary fibrosis);
– the patient will sleep on a hard bed, without a pillow under his head, in a prone position, to avoid vicious positions in flexion.
Physical therapy includes a program of physical exercises that must be performed daily in order to prevent spinal deformity and maintain chest expansion through respiratory gymnastics. Hydrotherapy and swimming are recommended because they have the role of optimizing the effect of physical therapy. Physiotherapy consists of electrotherapy sessions (interference currents, galvanic currents, TENS, ultrasound) that have an adjuvant role, being indicated during periods of remission of the disease.
Occupational therapy aims to re-educate normal movements, complementing the results of physical therapy. It is the final method of adapting free muscles to the possibilities of professional recovery until the recovery of normal movements. There will be 2-3 sessions per week, their duration not exceeding 60-90 min. During the application of these methods, the correction of static disorders of the spine will be followed by adopting positions that put the intervertebral disc at rest.
The patient will be forbidden to carry weights in his hands, exaggerated movements and vicious positions and positions favorable to the activity will be sought. Occupational therapy aims to return the patient to the basic profession. If this is not possible he will have to learn another trade. The therapeutic methods described prevent these patients from becoming infirm and socially dependent, keeping them as useful elements to society according to their personal possibilities and inclinations.