Ankylosing spondylitis is a type of arthritis that mainly affects the joints in your spine. It causes stiffness and can reduce your movement. Some of the bones of your spine may fuse together.
If you have ankylosing spondylitis, the bones in your spine become inflamed at the part where they attach to the tendons. They also get inflamed at the joints between your bones. Your body tries to mend the resulting damage to your joints by producing new bone. As new bone grows, it can eventually cause your spine to fuse together.
Although it usually starts in your spine, ankylosing spondylitis can affect any of your joints, especially your hips, knees and shoulders.
You can develop ankylosing spondylitis at any time, but it usually starts in your late teenage years or early twenties. Men are three times more likely to be affected than women.
Ankylosing spondylitis affects different people in different ways. You may have symptoms for many years before you’re diagnosed with ankylosing spondylitis because early symptoms are similar to back pain. Symptoms often develop gradually – they may be mild or severe, and can come and go.
Symptoms of ankylosing spondylitis include the following.
If you have any of these symptoms, see your GP.
Complications of ankylosing spondylitis include inflammation of your eye, known as iritis. Your eye may become red, painful and sensitive to light. It's important to treat this quickly as it can cause damage to your eye, and even blindness. If your eye becomes bloodshot and painful or you have problems with your sight, see your optometrist or GP straight away. An optometrist is a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses.
If you have ankylosing spondylitis, osteoporosis can develop in your spine. Osteoporosis is a condition that causes your bones to become weak and brittle, which can make them more likely to fracture (break). Also, if you have ankylosing spondylitis, your spine is stiff and less flexible. This can also increase your risk of a fracture if you fall or have an injury.
Ankylosing spondylitis can increase your chance of developing problems with your heart and lungs, such as heart disease or scarring of your lungs (fibrosis).
The exact reasons why you may develop ankylosing spondylitis aren't fully understood at present.
Ankylosing spondylitis can run in families. If you have a gene called HLA-B27, you may be more likely to develop the condition. Research has shown that nine in 10 white people who have ankylosing spondylitis have this gene. The proportion of people with the gene is lower in people from other ethnic groups. You can have a blood test to check if you have it. However, if you do have this gene, it doesn’t mean you will definitely get ankylosing spondylitis – it's likely other factors are involved too.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
If your GP thinks you may have ankylosing spondylitis, he or she will refer you to a rheumatologist. A rheumatologist is a doctor who specialises in diagnosing and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues. Your GP may also refer you to see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility).
There isn't a cure for ankylosing spondylitis. However, there are a number of treatments that can help to ease your symptoms and improve your quality of life.
Exercise may provide relief from pain and help to improve and maintain your posture, flexibility and mobility. It’s especially important to exercise your back so that it doesn’t stiffen in a bent position. A physiotherapist can give you exercises to do to help you maintain as much movement as possible. These may involve breathing exercises to keep your ribs and chest flexible. Doing physiotherapy in a pool (known as hydrotherapy) or swimming regularly can be particularly useful. This is because it can help to strengthen your muscles without putting weight through your joints.
There is little evidence to suggest that changing your diet by not eating certain types of food or eating particular foods will help. However, it’s important to eat a healthy, balanced diet in order to stay a healthy weight. If you’re overweight, this may increase the strain on your back and other joints, and may make your pain worse.
You may find that a hot shower or bath helps with stiffness in the morning. If you use hot water bottles or electric blankets, it may ease your pain. However, take care not to hold hot items directly against your skin as this may damage it. You may also find it helpful to sleep on a firm, supportive mattress to stop your back from curving, and to use a thin pillow.
If you find everyday tasks difficult because of the pain from ankylosing spondylitis, you may be able to get help from an occupational therapist. An occupational therapist is a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.
Painkillers and anti-inflammatory medicines
Your doctor will usually advise you to try non-steroidal anti-inflammatory drugs (NSAIDs) first, to help with your pain. NSAIDs will reduce inflammation and pain so that you can keep active. You can buy some NSAIDs, such as ibuprofen (eg Nurofen), over the counter. Other NSAIDs, such as naproxen, have to be prescribed by your doctor. If you take NSAIDs regularly, your doctor may suggest you take a medicine called a proton pump inhibitor as well. This medicine will protect your stomach and reduce the risk of side-effects from NSAIDs.
If you can’t take NSAIDs for any reason, your doctor may advise you to take another painkiller, such as paracetamol, instead.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Your doctor may offer you a steroid injection into your joints if they are very painful or swollen.
Disease-modifying anti-rheumatic drugs (DMARDs)
Depending on how severe your disease is, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate or sulfasalazine. These medicines are used for other types of arthritis that are caused by inflammation (for example, rheumatoid arthritis). They work by changing the actual disease process of ankylosing spondylitis and may help reduce the damage to your joints. It may take some time before you notice any effect.
Tumour necrosis factor (TNF) blockers
If you have severe ankylosing spondylitis and NSAIDs or DMARDs don’t help relieve your symptoms, your doctor may recommend a biological therapy. These include a type of medicine called a tumour necrosis factor (TNF) blocker, such as etanercept and adalimumab. TNF is a chemical that is made by your cells when you get inflammation. Speak to your doctor about the risks and benefits of taking TNF blockers.
Biphosphonates (for example, pamidronate) reduce the breakdown of bone and are used to prevent or treat osteoporosis. However, they are also sometimes used to treat ankylosing spondylitis. Your doctor may prescribe these if he or she thinks these medicines will help you.
Most people with ankylosing spondylitis don’t need surgery, but if your hip or knee is severely affected, your doctor may recommend replacing the damaged joint. In exceptional circumstances, you may need to have surgery on your spine or neck to try to straighten it.
You will probably be able to carry on with your daily life and go to work as usual. However, you may need to make some adjustments to your working environment and get special equipment to enable you to do your job more easily. Talk to your occupational health or HR manager for advice, or contact the Citizens Advice Bureau.
Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, December 2013.
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