Ankylosing spondylitis (AS)

Ankylosing spondylitis (AS) is a chronic, progressive disease that causes bony anastomoses to form at the spinal vertebral junctions, sacroiliac joints, spinal joints and spinal ligaments, resulting in gradual stiffening. The disease usually manifests itself between the ages of 16 and 30.

Symptoms

AS is characterised by cyclical periods of disease exacerbation and remission. 

Initial general symptoms include the presence of a subfebrile state, fatigue and weight loss.

Then, more advanced symptoms include:

• Pain in the lumbosacral region, radiating to the groin, buttocks and knee joints – found in most patients
• Arthritis in the ankles/knees and other joints
• Joint stiffness and increasing pain at night
• Gradual restriction of spinal mobility
• Anterior uveitis of the eyeball
• Changes in the circulatory system
• Other symptoms related to the lungs, kidneys, digestive system and nervous system
• Due to reduced quality of life, depression may occur

Inflammation takes place in the hip joints, bones, periosteum, tendons at the point of attachment to the bone (mainly in the Achilles tendon) and in the periarticular tissues. The changes also affect the muscles, which can result in spasms and even atrophy in the paravertebral region. The result of AS is limited mobility of the spine, forward leaning of the body (kyphosis) and severe disability.

Causes and risk factors

The exact cause of AS is not known. It’s an autoimmune disease, during which the immune system attacks its own cells and tissues. Because of the inflammation, calcium is deposited in the affected areas, causing ossification.

Risk factors that increase the likelihood of developing the disease are:

• Age – the first symptoms occur in young people between the ages of 16 and 30
• Gender – men get the disease on average three times more often than women
• Genetic factors – the presence of the HLA-B27 antigen and polymorphisms at the PTGER4 gene
• Family medical history – people with family members who have experienced autoimmune and joint-related diseases have a greater predisposition to AS

Treatment and complications

The primary diagnostic tests performed to diagnose AS are laboratory tests, spinal X-rays, MRIs and joint fluid testing.

Unfortunately, there is currently no method to fully cure AS.

The main goal of treatment is to halt the progression of the disease and reduce the patient’s pain.

Treatment of AS includes pharmacological methods in the form of non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, glucocorticosteroids (GCSs) and disease-modifying drugs (DMEs).

In patients experiencing severe pain and high joint disability, surgery (endoprosthesis) of the hip joint is suggested. Physical therapy to prevent joint stiffness is also extremely important.

It usually takes 5-7 years to make a correct diagnosis of AS due to the invisible lesions for the first few years. If left untreated, the disease is associated with disability and shortened survival time due to spinal fractures. If you have any of the symptoms mentioned above, you should immediately see a specialist (rheumatologist) for proper diagnosis and treatment.

An extremely promising avenue that expands the possibilities of diagnostic management for patients with AS is clinical research, which is producing more and more effective treatments that slow down the disease’s progression and increase the patient’s quality of life.