Pain in the SI from AS

Ankylosing spondylitis – what is it and what can you do?

I’ve just had a patient in who’s been recently diagnosed with Ankylosing spondylitis (AS).  It is interesting to note that he does have mid-back pain.  This has nothing to do with his AS but everything to do with his anterior head carriage!  He now has as good understanding of AS and knows what’s going on but it still took about 5 years to get to the diagnosis.

Our discussion about this treatment prompted me to answer some of the FAQs about AS.

Ankylosing spondylitis is common.

AS is the most common inflammatory rheumatic disease in the family of ‘spondyloarthritis’.  This is a group that differs from other types of arthritis because symptoms occur in both the joints and the sites where the ligaments and tendons meet the bone.

What does Ankylosing spondylitis do?

Doctors don’t know the cause of AS.  It starts between the ages of 17 and 45 and is more common in men.  9 out of 10 people with AS carry a gene known as human leukocyte antigen B27 (HLA-B27).  The gene marker for ASHaving this HLA-B27 genetic marker puts some people at higher risk for the disease, as do gastrointestinal infections and a family history of the condition, the Spondylitis Association of America (SAA) suggests.  However, having this gene doesn’t necessarily mean you’ll develop AS.  It’s estimated 8 in every 100 people in the general population have the HLA-B27 gene, but most don’t have AS.  

AS typically affects the joints in the spine, but it may also affect the hips, knees, and even organs such as the aorta (the body’s main artery) and the eyes.  People with AS tend to experience inflammation where the ligaments attach to the bone. One of the consequences is that there can be tissue scarring where the body heals from the inflammation.  This may result in extra bone forming. Over time, the ligaments may become bony and fuse in the spine, forcing people into a stooped position.  This type of damage isn’t reversible

What’s the treatment?

Treatment may include anti-inflammatory drugs, biologic medications such as tumor necrosis factor inhibitors, physical therapies, corticosteroids and, in severe cases, surgery.  For anyone who has AS, a first step in getting the right treatment is learning to separate fact from fiction.  Basic treatment for AS is like that of other inflammatory conditions.

Early diagnosis of Ankylosing spondylitis is important.

People who get diagnosed and receive treatment in two years are more likely to have a better outcome and achieve remission than those who delay getting diagnosed.  According to a study published in August 2015 in the journal Clinical Rheumatology, people who had delayed diagnosis and treatment experienced worse symptoms.  They also had more trouble with spinal mobility and functioning. They were more damaged and didn’t respond as well to treatment,

People with Ankylosing spondylitis will eventually have a deformity is NOT true.

Spinal fusion is possible but it’s only needed in severe cases.  It can usually be avoided with early treatment and lifestyle changes, such as doing extension exercises and being careful about your work and sleep posture.

If you have Ankylosing spondylitis, you’ll NOT necessarily need surgery.

Surgery is rarely required for people with AS.  Only in very severe cases would joint replacement in the knees or hips or surgery to correct a curved spine be needed.

Exercise will NOT make Ankylosing spondylitis more severe.

Researchers who reviewed six studies found that people who exercised at home appeared to have less pain and depression and had better quality of life than those who did not.  Their findings were published in October 2015 in the journal Clinical Rheumatology.  There is a common misconception that exercise will worsen AS.  This is not true.  People with AS tend to feel better after exercise.  Exercise can help keep you flexible, improve posture, and may lower pain.  The SAA recommends including daily exercise in every treatment plan for AS.

Ankylosing spondylitis is NOT curable: manageable but not curable.

There’s no cure for AS, but early treatment with a combination of NSAIDs and biologic medications is the best way to achieve remission.  A drug-free state is rarely achieved but that doesn’t mean you can’t live well with AS when you’re getting the right treatment.

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