Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that cause pain and stiffness in the back, neck and sometimes in other joints such as the hip and heels¹.

AS begins with inflammation around the bones in the spine or some joints, and later, it can sometimes cause the bones in the spine to fuse together, resulting in the loss of flexibility and the fusion of the spine, resembling “bamboo” with an immobile position^1,2.

• Intestinal microbiome: up to 70% of patients with AS have subclinical intestinal inflammation, suggesting that the origin of the disease may be in the gut
• Infections
• Mechanical stress
• Changes in the immune system
• Gender

Extra-articular involvement

Extraskeletal organs may also be affected by this disease. The most common extraarticular manifestations of AS include⁷:

>50% Inflammatory bowel disease

25% to 35% Acute anterior uveitis 

-10% Psoriasis

AS is also associated with⁷:

• An increased risk of cardiovascular disease.
• Pulmonary complications as diminished chest wall expansion and decreased spinal mobility predispose patients to a restrictive pulmonary pattern.

AS is diagnosed based upon the recognition of a pattern of clinical, laboratory, and imaging finding characteristic of the disease^8,9.

• Physical examination⁹
  Assessment of your flexibility and joint tenderness.
• Blood test to look at inflammatory markers^8,9
  C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can be assessed in patients suspected of AS.
• Blood test which can identify if you carry the HL-B27 gene⁹
• X-rays⁹
  X-rays will show if there have been any changes to your bones and joints such
  as extra bone growth or fusion.
• Magnetic resonance imaging (MRI) fusion⁹
  MRI will show if there is any inflammation around your joints.

Nonsteroidal anti-inflammatory medications (NSAIDs)
In many patients, NSAIDs are the only medications required as they are efficient in alleviating AS symptoms in 70-80% of patients.

Biologic therapy
Tumour necrosis factor (TNF)-α inhibitors. TNF inhibitors are recommended for patients with an inadequate response to initial therapy with NSAIDs.
Interleukin (IL)-17 inhibitors. In patients who have contraindications to the use of TNF inhibitors, treatment with IL-17 inhibitors is recommended.

Glucocorticoids
Local injections of glucocorticoids into the involved joint are an option for treating arthritis as they could provide immediate symptom relief.

You can reduce the chance that your conditions will cause problems if you¹:

• Stop smoking (you will be less likely to have breathing problems)
• Get plenty of calcium and vitamin D (you will keep your bones from getting weak)
• Do exercise (you will prevent some of the stiffnes caused by AS)
• Use a thin pillow (sleeping on a thick pillow can cause neck problems in people with AS)

Increased flexibility
The more flexible you are the easier it is to do everyday tasks.

Increased range of movement
The more mobility you have the easier it is to do things.

Improved posture
Better posture makes you feel better in yourself and reduces feelings of self consciousness.

Improved sleep
Exercise is physically tiring which improves sleep quality, ensuring you wake feeling refreshed.

Reduction in stiffness and pain
Exercise can result in less pain at night and improved sleep quality.