Understanding Ankylosing Spondylitis: Causes, Symptoms, and Treatment Options

What is ankylosing spondylitis (AS)?

It is a chronic inflammatory rheumatic disease that mainly affects the spine.

As the scientific term ankylosing spondylitis or ankylopoetica (i.e. associated with stiffening) indicates, the inflammatory processes in the spine can lead to hardening, restricted mobility, and malposition of the spine.

The course of the disease

The onset of the disease is possible at any age but is most common in the 2nd and 3rd decades of life. It typically begins with pain in the lower lumbar spine and the sacroiliac joints. The pain is unrelated to stress, it occurs primarily at rest, it radiates sometimes into the thigh and hip region.?

The patient with ankylosing spondylitis have usually pain at night, which wakes up the affected person, and causes him to get up and walk around. One of the more important symptoms is prolonged morning stiffness for more than 45 minutes, which improves during the day.

The further course can be very different. As the disease progresses, pain usually increases in the higher sections of the lumbar spine, thoracic spine, and cervical spine. Pain when coughing and sneezing are also typical, as well as tremors that radiate in the form of a belt, possibly also tender swellings in the area where the ribs and collarbones are connected to the breastbone. Some patients can also experience temporary inflammation in the area of medium-sized and large joints (shoulder, elbow, knee and ankle joints, hip joints), extremely rarely from hand, finger, and toe joints.

?Inflammation of tendon attachments, such as in the area of the Achilles tendon (heel pain), as well as inflammation of the iris on the eye in about 35% of patients (iritis or iridocyclitis). Occasionally, ankylosing spondylitis is combined with chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis). age and early retirement is only to be feared in exceptional cases where the course is very severe.

In the case of very unfavorable occupations, retraining may have to be considered at an early stage. The average life expectancy is statistically practically no different from that of the general population.

?

Causes and prevalence

The exact cause of ?AS is not yet known in detail. As with other inflammatory diseases, however, a disorder of the body's defense system (immune system) must be assumed, in which antibodies are formed against the body's tissue and thereby cause the inflammatory reaction. The increased occurrence of this disease in individual families and the disproportionately frequent detection of the HLA-B 27 factor indicate that although not the disease itself, the predisposition to it is genetically determined as an inherited trait, i.e. innate. The HLA-B27 trait can be detected in approximately 96% of all AS patients, but only in 8% of the general population who do not suffer from this disease. Similar to a blood group, the presence or absence of HLA-B27 is determined from birth and does not change throughout life.

It is not known if there are other reasons. In addition to the genetic predisposition”, that causes this incorrect reaction of the immune system. There are similar symptoms after viral or bacterial infections, but these are usually limited in time

Also discussed as possible triggers are extreme cold and wet conditions and other extreme physical or mental stress.

?

Treatment options:

Regular physiotherapy adapted to the stage of the disease is of the utmost importance. It should maintain mobility, avoid stiffening of sections of the spine in an unfavorable malposition, and train less stressed muscles. Physical measures such as heat treatment (e.g. mud or fango baths) and massages can be used as support, which promotes blood circulation in the tissue and counteracts pain-related muscle tension. In isolated cases, cold therapy showed a good effect. However, these passive treatment measures can in no way replace physiotherapy. Sports activities are also extremely helpful and support physiotherapy significantly, and, like gymnastics, often also have a pain-relieving effect?

For drug therapy, primarily Cortisone-free anti-rheumatic drugs are considered, which relieve or even eliminate the pain and also work directly anti-inflammatory, which makes them different from pure painkillers. Since the anti-rheumatic drugs help prevent pain-related protective postures and make intensive physiotherapy and sports possible, they contribute significantly to the course of the disease.

Furthermore, it is often only possible to sleep through the night undisturbed by taking anti-rheumatic drugs, and this has a positive effect on your general condition and general performance.

The anti-rheumatic drugs available today are well tolerated, problems are most likely to occur regarding the stomach and duodenum. there are hardly any problems with medication through the simultaneous administration of highly effective stomach-protecting substances.

For cases with a highly active course of the disease, the administration of so-called biologics (TNF-alpha antagonists, etc.) opens up good therapeutic options. These medications have been used successfully for over 15 years

The use of cortisone with Ankylosing spondylitis occurs in exceptional situations, for example in severe relapse situations or joint involvement (here possibly as an injection into the inflamed

joint) and in iris inflammation

Surgical measures, such as straightening operations in cases of significant functional impairment or fixed misalignment of the spine, are only extremely rarely necessary

?If the therapy measures described are carried out consistently.?

Whenever redness, pain in the eye, and visual disturbances occur, an ophthalmologist should be consulted immediately, because only immediate therapy can prevent visual impairment.?

All medication and physical therapy measures should be coordinated and discussed with the treating doctor.

Regular follow-up with the treating rheumatologist, at least twice a year, is of the utmost importance.

To know more information and to book an appointment visit Dr. Moataz Clinic or call 8002211.

?