What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation in the spine and other parts of your body.

Typically, the joints and ligaments of the spine allow us to move and bend. Over time, ankylosing spondylitis can cause stiffness due to inflammation in the joints and tissues of the spine.

In severe cases, this may lead to vertebrae (backbone) fusion. Fusion of the vertebrae can result in a rigid and inflexible spine.

What are the symptoms of ankylosing spondylitis?

Symptoms vary from person to person and develop gradually over months or years. Symptoms may include:

• Low back pain
  
  • Develops gradually
  • Worst in the morning (after rest)
  • Improves with activity
  • Lasts more than 3 months
  • Associated with morning stiffness
• Arthritis (inflammation of joints)
• Fatigue
• Hip, heel, and shoulder pain

What are the risk factors for ankylosing spondylitis?

Risk factors for ankylosing spondylitis include:

• Genetics: HLA-B27 gene
• Family history: You are three times more likely to develop ankylosing spondylitis if there is a close relative, such as a parent or a sibling, with the condition.
• Smoking

How is ankylosing spondylitis diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

It can be challenging to diagnose ankylosing spondylitis as the condition develops gradually, and there is no conclusive test to confirm the diagnosis.

• Blood test: To check for signs of inflammation. When inflammation is present, the erythrocyte sedimentation rate (ESR) is elevated.
• X-ray: Common signs of advanced ankylosing spondylitis include damage to the joints at the base of your spine (the sacroiliac joints) and the formation of new bone between the vertebrae (backbone), which can be seen on a lower back x-ray.
• Magnetic resonance imaging (MRI): MRI may highlight changes in the sacroiliac joints that were not apparent in the x-ray.
• Genetic testing: Most individuals with ankylosing spondylitis carry the HLA-B27 gene, although not all those with the HLA-B27 develop the disease.

How is ankylosing spondylitis treated?

Your treatment will depend on your symptoms and the severity of your condition. Treatment aims to relieve your symptoms, enable you to carry out your regular activities, and prevent further complications.

• Physiotherapy and exercise
  
  • Being physically active can improve your posture and spinal range of motion, as well as to prevent your spine from becoming stiff and painful.
  • In addition to exercise, physiotherapy is critical to treating ankylosing spondylitis. A physiotherapist can recommend the most effective exercise programme that would suit your needs.
• Medication
  
  • Non-steroidal anti-inflammatory drugs (NSAIDs) are used to ease joint pain and inflammation.
  • Your doctor may recommend steroid injections if a particular area is causing the most pain.
  • Anti-tumour necrosis factor (anti-TNF) therapy may be recommended if your symptoms are still uncontrolled despite NSAIDs and exercises.
  • Disease-modifying anti-rheumatic medicines (DMARDs) such as sulfasalazine and methotrexate are used to ease inflammation and control the disease
• Surgery
  

  Most patients with this condition will not require surgery. However, joint replacement surgery may be needed if a joint is severely damaged. For example, total hip replacement (arthroplasty) or spinal surgery.

What are the complications of ankylosing spondylitis?

Complications of ankylosing spondylitis include:

• Reduced flexibility: Ankylosing spondylitis usually affects the lower back due to the fusing of the bones. This makes it difficult to move your back, causing your posture to be fixed.
• Joint damage
• Iritis: The front part of the eye becomes red and swollen. This causes your eye to be red, sensitive to light (photophobia), and painful. Seek immediate medical attention if you develop iritis, as it can lead to complete or partial vision loss if not treated immediately.
• Spinal fractures and spinal cord injuries
• Heart valve disease

Ankylosing Spondylitis vs Rheumatoid Arthritis

Ankylosing spondylitis mostly affects the spine and sacroiliac joints, whereas rheumatoid arthritis usually affects the joints in the extremities, such as hands and wrists.

Book an appointment at Pantai Hospitals

Speak to your doctor to know more about ankylosing spondylitis. Early detection of ankylosing spondylitis makes it easier to treat the condition with effective and appropriate treatment. A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding Ankylosing Spondylitis. We assure you the best possible care tailored to your specific needs.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.