Ankylosing Spondylitis: Causes, Symptoms, and Treatment

By SWA

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that primarily affects the spine and sacroiliac joints (where the spine meets the pelvis). Over time, this condition can cause vertebrae to fuse, leading to stiffness, pain, and, in severe cases, a hunched posture. AS is part of a group of diseases known as spondyloarthropathies, which also affect other joints and organs. While there is no cure, early diagnosis and treatment can help manage symptoms and prevent complications.

Causes of Ankylosing Spondylitis

The exact cause of AS remains unknown, but research suggests that genetics, immune system dysfunction, and environmental factors all contribute to its development.

1. Genetic Factors

A key genetic link to AS is the HLA-B27 gene. Around 90% of people with AS carry this gene, though not everyone with HLA-B27 develops the disease. This indicates that additional genetic or environmental factors are necessary for AS to develop. Other genes, such as ERAP1 and IL-23R, have also been associated with AS.

2. Immune System Dysfunction

AS is considered an autoimmune or autoinflammatory disease, where the immune system mistakenly attacks healthy joints, leading to chronic inflammation in the spine and other areas. This prolonged inflammation causes pain and, over time, can result in the fusion of spinal bones (a condition known as bamboo spine).

3. Environmental Triggers

  • Infections – Some researchers believe that an infection (bacterial or viral) could act as a trigger in genetically susceptible individuals.
  • Gut Bacteria Imbalance – Studies suggest that an imbalance in gut microbiota may play a role in AS by affecting immune system responses.

4. Other Risk Factors

  • Family History – People with a family history of AS are at higher risk.
  • Sex – AS is more common in men than women.
  • Age – Symptoms typically begin between ages 15 and 35.
  • Ethnicity – More common in Caucasians, though it can affect people of all backgrounds.

Symptoms of Ankylosing Spondylitis

AS symptoms develop gradually and vary from person to person. The most common ones include:

1. Spine & Joint Symptoms

  • Chronic Lower Back Pain & Stiffness – Pain is usually worse in the morning or after periods of inactivity and improves with movement.
  • Hip & Buttock Pain – Due to inflammation of the sacroiliac joints.
  • Loss of Spinal Flexibility – Over time, the spine may become rigid, limiting movement.
  • Pain & Swelling in Other Joints – AS can also affect the shoulders, knees, and ankles.

2. Other Common Symptoms

  • Fatigue – Chronic inflammation can lead to severe tiredness.
  • Neck & Upper Back Pain – Pain may spread upwards as the disease progresses.

3. Extra-Spinal Symptoms (Beyond the Spine)

  • Eye Inflammation (Uveitis/Iritis) – Causes red, painful eyes, blurred vision, and sensitivity to light.
  • Chest Pain & Breathing Difficulty – Due to inflammation where ribs meet the spine, restricting chest expansion.
  • Digestive Issues (IBD-like Symptoms) – Some people develop conditions similar to Crohn’s disease or ulcerative colitis.
  • Heart Problems – Rare, but may include aortic valve disease or inflammation of the heart.

4. Late-Stage Symptoms

  • Fusion of the Spine (Bamboo Spine) – In severe cases, the vertebrae may fuse, causing a permanently curved posture.
  • Mobility Issues – Advanced AS can significantly limit movement.

Diagnosis of Ankylosing Spondylitis

Since AS symptoms develop gradually, early diagnosis is essential to prevent complications. Doctors use the following methods to confirm AS:

  • Medical History & Physical Exam – Checking for pain, stiffness, and mobility issues.
  • Imaging Tests – X-rays, MRI, and CT scans help detect spinal inflammation and changes in the sacroiliac joints.
  • Blood Tests –
    • HLA-B27 test (genetic marker for AS)
    • C-reactive protein (CRP) & Erythrocyte Sedimentation Rate (ESR) (inflammation markers)

Treatment & Management of Ankylosing Spondylitis

There is no cure for AS, but treatment focuses on managing symptoms, reducing inflammation, and maintaining mobility.

1. Medications

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – Ibuprofen, naproxen, and indomethacin help reduce pain and inflammation.
  • Biologics (TNF Inhibitors, IL-17 Inhibitors) – Used for severe cases to block inflammatory pathways.
  • DMARDs (Disease-Modifying Anti-Rheumatic Drugs) – Sulfasalazine may help if peripheral joints (e.g., knees) are affected.

2. Physical Therapy & Exercise

  • Stretching & Postural Exercises – Maintain spinal flexibility and posture.
  • Low-Impact Activities – Swimming, yoga, and walking help keep joints active without excessive strain.

3. Lifestyle Changes

  • Quit Smoking – Smoking worsens AS and increases the risk of complications.
  • Good Posture Practices – Helps prevent spinal deformities.
  • Healthy Diet – An anti-inflammatory diet rich in omega-3s and fiber may help.

4. Surgery (Rare Cases)

  • Joint Replacement Surgery – If hip or knee joints are severely damaged.
  • Spinal Surgery – In extreme cases of spinal fusion causing significant disability.

Conclusion

Ankylosing spondylitis is a lifelong condition that primarily affects the spine, but early diagnosis and proper management can significantly improve quality of life. While genetics play a major role, environmental and immune system factors also contribute to AS. Recognizing symptoms early and seeking medical attention is crucial for preventing severe complications. With a combination of medications, physical therapy, and lifestyle adjustments, individuals with AS can lead active and fulfilling lives.


© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

Comments

Post a Comment

Popular posts from this blog

Schnitzler Syndrome: A Rare Autoinflammatory Disorder

By SWA
Schnitzler syndrome is a rare, chronic autoinflammatory disease characterized by chronic urticaria (hives), recurrent fever, joint pain, and monoclonal gammopathy (abnormal proteins in the blood). First described by Dr. Liliane Schnitzler in 1972 , this condition is often misdiagnosed, leading to years of untreated symptoms before a correct diagnosis is made. The case report, " A 58-Year-Old Woman With Urticaria, Fever, and Joint Pain " , describes a case that closely aligns with my own experience with this challenging disorder. Key Features of Schnitzler Syndrome Schnitzler syndrome presents with a characteristic set of symptoms, though not all patients experience them in the same way: Chronic Urticaria (Hives) – Persistent, non-itchy or mildly itchy red patches that do not respond to antihistamines. Monoclonal Gammopathy (IgM or IgG type) – Abnormal monoclonal immunoglobulin detected in the blood (most commonly IgM ). Recurrent Fever – Unexplained fever episodes, often...
Read more

Dysferlin Protein: Key Roles, Genetic Locations

By SWA
Image
The purpose of this article is to share and discuss the details of a new discovery, which is highlighted within: CRISPR-Cas9: A Breakthrough Tool to Repair the DYSF Gene The dysferlin protein plays an essential role in maintaining the integrity of muscle cell membranes, particularly in tissues that endure significant mechanical stress, such as skeletal and cardiac muscles . Encoded by the DYSF gene , dysferlin is indispensable for repairing damaged cell membranes after injury caused by muscle contraction or external forces. This article explores the main locations where dysferlin is produced, its role in muscle repair, and supportive nutritional and therapeutic strategies for individuals with dysferlin deficiency, such as those affected by dysferlinopathies (e.g., Limb-Girdle Muscular Dystrophy Type 2B or Miyoshi Myopathy). Currently, there is no definitive answer as to why the severity of dysferlin protein expression or depletion varies. Do pathogens play a role in the methylation o...
Read more

Toxic Skin Condition Post-mRNA COVID-19 Vaccination

By SWA
Image
Identifying Severe Skin Conditions Post-Vaccination Following administration of the BioNTech mRNA vaccine, a small subset of individuals may develop severe and complex reactions. These reactions are often misdiagnosed or misunderstood due to their rarity and diverse presentation. This essay examines a case characterized by severe skin conditions, systemic symptoms, and complications such as hypercalcemia and crystal formation. It highlights the need for accurate diagnosis, holistic management, and increased awareness of these rare but significant vaccine-related adverse events. Initial Symptoms and Misdiagnoses Severe symptoms began shortly after the first dose of the BioNTech vaccine, initially presenting as petechiae, diagnosed by a rheumatologist. However, following the second dose, symptoms rapidly escalated, resulting in intense burning pain and thinning of the skin. The skin on the legs and thighs became paper-thin and could tear with the slightest touch, with the affected area e...
Read more