Ankylosing spondylitis is an inflammatory disease that affects the spine, causing stiffness and difficulty moving it due to joint stiffness.
Ankylosing spondylitis causes severe pain that hinders the patient from performing his daily tasks and makes him an inactive member of society, especially as it affects young people in the prime of life around the third and fourth decades, which leads to great economic and health losses in society.
Therefore, the patient must use health care to manage and control the ankylosing spondylitis disease to return to everyday life. The condition is not entirely curable, but compliance with the correct treatment drastically improves the patient's life. Follow us in this article to learn about ankylosing spondylitis in detail and how to treat it in Turkey.
What is ankylosing spondylitis?
Ankylosing spondylitis is an autoimmune disease, and it is a chronic inflammatory disease that affects young people around the third or fourth decade of life and leads to pain in various parts of the body. The pain is mainly concentrated in the back, appears at night, and lasts for a long time, causing difficulty in movement.
The back is not the only place for pain to appear in Ankylosing spondylitis,the sacroiliac joint is also common to be affected, causing pain in the gluteal region (buttocks) in the lower back of the patient, which begins as unilateral pain and then becomes on both sides. The shoulder, ankle, hip and knee joints are also affected in ankylosing spondylitis.
The mechanism of ankylosing spondylitis depends on the occurrence of a chronic inflammatory reaction in the joints and the attachment of ligaments and tendons on the bones due to the formation of immunity from the body against these tissues (the body attacks itself - autoimmune), which leads to erosion of the joints and the rupture of the tendons or their destruction significantly and the formation of bone spurs and then fusion vertebrae together. This leads to spine stiffness and difficulty moving the neck and back (stiff neck and increased forward bending of the back).
Symptoms of ankylosing spondylitis
The symptoms of ankylosing spondylitis are divided into orthopedic symptoms that affect the spine and other joints of the body and extra-osseous symptoms that may affect the eyes, intestines, or other organs in a patient with ankylosing spondylitis, and the symptoms vary significantly from one patient to another.
Orthopedic symptoms in ankylosing spondylitis
These symptoms include pain, stiffness, and difficulty moving the joint affected by the inflammation. The joints between the vertebrae and the ligaments connected to them are affected, in addition to the bones articulating with the back vertebrae.
The most important of these joints is the sacroiliac joint (the joint between the spine and the pelvic bone) and the costovertebral joints. Joint injury leads in Ankylosing spondylitis to the occurrence of stiffness and pain in:
- lower back
- chest (thoracic cage)
- thigh from the back
This pain usually appears in the middle of the night and lasts for several hours. It does not go away with rest, and the patient may wake up because of it. This pain may worsen in the morning, in addition to stiffness, difficulty moving the affected joint, and swelling. These symptoms usually last for at least three months. Symptoms such as:
- The appearance of pain after prolonged rest
- Mild heat
- Anorexia and weight loss
- Osteoporosis and fractures
- Difficulty breathing deeply due to limited movement of the chest
- Constant fatigue and exhaustion
- Back bending and spine forward
- Inflammation of the fibrous disc between the vertebrae in the spine
- Pain in other joints due to Enthesitis (where tendons and ligaments attach to bones).
Complications of ankylosing spondylitis
The disease of ankylosing spondylitis is not limited to the spine. Some call the injuries outside the bones of this disease complication of ankylosing spondylitis, which are as follows:
Extraosseous symptoms in ankylosing spondylitis
Ankylosing spondylitis may affect organs outside the spine and the musculoskeletal system, which misleads the diagnosis of the disease. Therefore, it is necessary to know the extra-osseous symptoms of ankylosing spondylitis, which are:
Ocular incidence of ankylosing spondylitis
Ocular infection of ankylosing spondylitis causes the following:
- Eye pain and redness
- Blurred vision
- light fear
This is because it causes inflammation of the anterior uveitis in the eye.
Gastrointestinal manifestations in ankylosing spondylitis
The gastrointestinal tract is also affected by a condition called inflammatory bowel disease (IBD) (including Crohn's disease andUlcerative colitis) causing bloody mucous diarrhea and bouts of abdominal pain.
Neurological symptoms of ankylosing spondylitis
Arthritis in the spine may affect neighboring nerves due to a fracture or dislocation of the vertebrae. As a result, neurological symptoms appear as follows:
- Tingling and numbness
- Loss of sensation or movement
This is according to the affected nerve and the organs responsible for its innervation.
Symptoms of cardiac, renal and pulmonary injury in ankylosing spondylitis
Sclerotic spondylitis may cause arrhythmias or inflammation of the origin of the aorta due to the progression of the disease in rare cases.
Chronic inflammation in the patient may also cause pulmonary or renal fibrosis, but this condition is rare in the case of ankylosing spondylitis.
Ankylosing spondylitis and pregnancy
There is no evidence of the effect of ankylosing spondylitis on pregnancy or the ability to have children, but planning for the date of pregnancy remains essential to change some of the medications the patient takes in proportion to the pregnancy. Symptoms of rheumatic spondylitis may ease in some women during pregnancy.
What are the causes of ankylosing spondylitis?
Ankylosing spondylitis affects young males, often between 20-40 years old. The direct cause of ankylosing spondylitis that affects the spine or the joints surrounding it has not yet been known. Still, studies have found a strong association between HLA-B27 carriers on white blood cells and an increased incidence of ankylosing spondylitis.
Not all carriers of this group will develop spondylitis (but a large proportion of them are estimated at 80%), and not all people with spondylitis have it. However, according to recent studies, there is a significant association between the disease and the presence of this gene in the patient. There is a possibility of 50% inheriting this gene, meaning that ankylosing spondylitis may be a genetic disease in some cases.
Diagnosis of ankylosing spondylitis
Diagnosing ankylosing spondylitis depends initially on the clinical story, the symptoms the patient complains about, and then on the clinical examination. After seeing these manifestations, the doctor suspects that his patient has ankylosing spondylitis, especially if the patient is a young man in the prime of life due to the prevalence of rheumatoid arthritis in this group.
As a result, several radiological and laboratory investigations are required, namely:
- Sedimentation rate (ESR) test: The sedimentation rate rises in many diseases, including ankylosing spondylitis.
- X-Ray of the spine or affected joints
- HLA-B27 clique analysis
The doctor may need other, more specific tests if the case is suspected of different pathological conditions to differentiate between them and diagnose the patient correctly. The diagnosis of rheumatoid arthritis depends on specific criteria, and the presence of one of them may greatly outweigh the disease, namely:
- Inflammatory lower back pain that lasts for more than three months
- The difficulty of the movement of the lower spine and the patient's inability to bend forward or to the sides
- The difficulty of the movement of the chest and the inability of the patient to breathe deeply
Ankylosing spondylitis treatment in Türkiye
Ankylosing spondylitis is treated by a doctor specializing in rheumatic diseases (autoimmune diseases, rheumatism, and joints) Rheumatologist, who accurately assesses the patient's condition and prescribes specific treatment based on his condition.
Treatment methods aim to control the symptoms of the disease and treat the pain and stiffness caused by it. It includes drug therapy, physical therapy, and surgical treatment in some cases, all of which significantly improve the patient's condition and slow (and may stop) the progression of the disease. There is no definitive cure for ankylosing spondylitis.
Pharmacotherapy for ankylosing spondylitis
Medicinal groups prescribed by a rheumatologist for treating a rheumatic disease affecting the spine, such as ankylosing spondylitis, vary for several treatment lines.
The stronger the drug used for treatment, the greater the side effects resulting from its use, so we do not proceed with severe medications at the beginning of treatment. We use the most beneficial medicine for the patient and have the least cost and side effects. Such as:
Pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs).
Paracetamol and ibuprofen are the primary medications for managing and treating ankylosing spondylitis. If they do not relieve the patient’s pain, we use drugs with a more substantial effect.
Anti-rheumatic and disease-modifying drugs
These drugs reduce the inflammatory process in the body and improve the patient's symptoms, especially in the hands and feet, in addition to protecting the joints from destruction. Still, they are considered weakly effective for symptoms related to the spine.
The most important of these drugs are methotrexate and sulfasalazine. When using these drugs to treat ankylosing spondylosis, the patient must be monitored continuously to avoid any side effects that may occur as a result of treatment. It is excellent for controlling pain and stiffness in the patient's joints.
Biological therapy for ankylosing spondylitis
This category is the latest drug for treating ankylosing spondylitis, but its use must be done with caution and under the supervision of a specialist doctor. These drugs work to reduce the process and stop the autoimmune process that causes the disease by targeting one of the essential components of this process (such as tumor necrosis factor TNF or interleukin 17); among the most important of these drugs (a new drug for the treatment of rheumatic ankylosing spondylitis):
- Citrolizumab Pegol
Treatment of ankylosing spondylitis with steroids
Steroid drugs (such as cortisone) treat attacks of ankylosing spondylitis. They are either injected into the inflamed joint or intramuscularly. There are also oral tablets and eye drops.
We resort to steroid drops for eye infections associated with rheumatic spondylitis. This drug class is not used for a long time in treatment due to its side effects and like any other drug. Refer your doctor immediately if you notice any side effects as a result of the treatment of ankylosing spondylitis.
Physiotherapy for ankylosing spondylitis in Türkiye
Physiotherapy is essential in managing ankylosing spondylitis to maintain muscle strength and prevent stiffness in the spine or joints and loss of mobility. You can learn more about Physiotherapy in Türkiye from here.
Our physiotherapist will advise you on daily exercises (ankylosing spondylitis exercises) and maintaining a specific posture suitable for your condition. One of the modern methods we also have is hydrotherapy for ankylosing spondylitis, which includes a set of exercises in a warm water pool to improve the symptoms of the disease.
Surgical treatment of ankylosing spondylitis in Türkiye
Most patients with ankylosing spondylitis do not need surgery because most symptoms can be controlled with medication. Surgery is beneficial for patients with ankylosing spondylitis if one of the joints is destroyed, which requires replacement, and the most important of them Hip replacement orKnee joint replacement If it is severely damaged.
Usually, we do not resort to surgical work on the spine except in exceptional cases where intervention benefits the patient's life and improves his condition. Surgical position on the spine requires excellent experience. Turkey's most skilled orthopedic doctors are available in our center to perform such specific operations.
Ankylosing spondylitis is an autoimmune disease that affects the patient's joints and may destroy them. Many other joints outside the spine are affected, and the injury is not limited to joints and bones only. Eye or digestive injuries may also occur. Ankylosing spondylitis is treated with medication and physical therapy, and we may use surgery to repair damaged joints.