Ankylosing spondylitis 

Hello students and friends, today we are going to discuss what is ankylosing spondylitis, its cause, signs and symptoms, risk factors, and its treatment.

Let us discuss first what is ankylosing spondylitis,

Ankylosing spondylitis is an inflammatory disease/arthritis in which the spine and large joints are affected.

~It primarily affects the spine and it also affects other joints.

~It is an autoimmune illness in which immune cells get activated when certain bacteria enter or pass into the bloodstream and cytokines(chemical) produced by the immune cells.

~When cytokines get activated, they active other cells, and these cells migrate to the joints through the blood which leads to swelling in the joints. When joints swell it results in pain and swelling of the joints.

~Especially sacroiliac joint is affected more.

~Pain in the ribs, chest, buttocks, and in the entire back or neck also occur.

~Pain is felt generally at night and in the early morning.

~The blood supply to the joints reduces during sleep, cytokines get pent up and induces stiffness and pain in the joints.

~When a person sleeps, he/she may felt pain(nocturnal) during turning into the bed.

~When a person wakes up in the morning, blood flow increases or back to normal, cytokines washed away and the pain reduces.

~Sometimes it also affects other joints of the body- knee, shoulder, and ankle.

Normal spine view

Causes

• Its exact cause is still unknown, but genetic and environmental factors can cause ankylosing spondylitis.
• Almost 80-90% of patients with ankylosing spondylitis have the HLA-B27 gene.
• HLA-B27 increases the risk of having ankylosing spondylitis, however other genes with respect to environmental factors also cause ankylosing spondylitis.
• According to researchers, more than 60 genes are associated with ankylosing spondylitis.
• Genes are identified as- ERAP 1, IL-12, IL-17, and IL-23.

Early signs and symptoms

Symptoms ordinarily begin to appear in late adolescence or early adulthood.

Some symptoms are:

1. Neck pain
2. Mild fever
3. Loss of appetite
4. Sweating at night
5. Stiffness and pain in the lower back, hips, and buttocks.
6. Pain in tendon and ligaments.

Late symptoms include-

1. Pain, stiffness, and tenderness are seen on both sides of the body
2. Postural changes occur
3. Tiredness.

Ankylosing spondylitis

Risk factors

1. Mostly affect a person with age 15-40years.
2. Men(3times)>women.
3. Genetic or any family history.

Which areas are most affected?

Areas which are mainly affected are-

1. Spine
2. Shoulder joint
3. Joints of the hands and feet
4. Thigh area
5. Hip joint
6. Neck 
7. Ribs.

Diagnosis

• Physical examination is done to examine the range of motion(ROM) in the spine.
• When a physical examination is done, it shows a change in posture with pain in a different position with difficulty in breathing(expansion of chest).
• X-ray is done to check changes in bone and joints.
• MRI used for scanning more detailed images of bone and soft tissue. It is expensive.
• The blood test can be done but it doesn't reveal that much information about ankylosing spondylitis as it gives information about inflammation and inflammation can be caused by many diseases not only ankylosing spondylitis.
• HLA-B27 gene is tested in the blood test, but most of the people who have that gene don't have ankylosing spondylitis.

Treatment

1. NSAIDs(non-steroidal anti-inflammatory drugs)- indomethacin, and naproxen.
2. TNF blockers(tumor necrosis factor)- adalimunab, certolizumab, etanercept, golimumab and infliximab.
3. Interleukin-17 inhibitor(IL-17)- secukinumab and ixekizumab for body defense against infection and inflammation.
4. Physiotherapy is an important part of the treatment- includes deep breathing exercises, jogging(moderate to high impact exercises are recommended but with some restrictions), group exercises, PNF(proprioceptive neuromuscular facilitation), and an exercise program.
5. Electrotherapy
6. TENS(transcutaneous electrical nerve stimulation)
7. Hot compression
8. Locally injected corticosteroids
9. DMARDs(disease-modifying anti-rheumatic drugs)- sulfasalazine and methotrexate.
10. Surgery- however, surgery is not required as such but artificial joint replacement surgery may be the last option for some people with an advanced joint disease which affects hips or knees.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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