Neck pain and Back pain in Ankylosing spondylitis:
Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies). It is one of the causes of back pain and neck pain in adolescents and young adults with a genetically inherited tendency where is the HLA-B27 gene can be detected in the blood of most patients. The optimal treatment involves medications that reduce inflammation or suppress immunity, physical therapy, and exercises. In this blog, we will explore the common questions related to Ankylosing Spondylitis
What is Ankylosing spondylitis?
Ankylosing Spondylitis is a disease process associated with chronic inflammation of the joints related to spine, particularly the sacroiliac joints. The sacroiliac joints are located at the base of the low back where the sacrum which is the bone above the tailbone meets the iliac bones which are bones on either side of the upper buttocks. Chronic inflammation in these spinal joints leads to pain and stiffness in and around the spine, including the neck, middle back, lower back, and buttocks. Over time, chronic inflammation of the spine can lead to a complete cementing together of the bones, a process referred to as ankylosis which leads to loss of mobility of spine presenting as stiffness. Ankylosing spondylitis is also a systemic disease and it can cause inflammation in and injury to other joints away from the spine manifest as arthritis, as well as to other organs, such as the eyes, heart, lungs, and kidneys. It is two to three times more common in men than in women. The most common age of onset of symptoms is in the second and third decades of life.
What causes Ankylosing Spondylitis?
Ankylosing spondylitis is believed to have a genetically inherited tendency with nearly 90% of such patients born with a gene known as the HLA-B27 gene, which can be detected by Blood tests. Even among individuals whose HLA-B27 blood test is positive, the risk of developing ankylosing spondylitis appears to be further related to heredity. These genes seem to play a role in influencing immune function. How inflammation occurs and persists in different organs and joints in ankylosing spondylitis is a subject of active health research.
What are the symptoms and signs of Ankylosing Spondylitis?
Inflammation of the spine can lead to fatigue, pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens with loss of range of motion noticeable over months. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. Motion, heat, and a warm shower often reduces pain and stiffness in the morning. Those who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine (ankylosis). Once fused, the pain in the spine disappears, but the affected individual has a complete loss of spine mobility. A sudden onset of pain and mobility in the spinal area of these patients can indicate bone breakage.
Chronic spondylitis and ankylosis cause forward curvature of the upper torso (thoracic spine), which limits breathing capacity. People with ankylosing spondylitis can also have arthritis in joints other than the spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or redness in joints such as the hips, knees, and ankles. Other areas of the body affected by ankylosing spondylitis include the eyes, heart, and kidneys.
Which health care professionals treat Ankylosing Spondylitis?
Rheumatologists are internal-medicine subspecialists with a particular interest in diagnosing and treating patients with ankylosing spondylitis. Orthopaedicians and primary care physicians can also aid in pain management. Spine surgeons are involved in the management of spinal deformities once fixed fusion or ankylosis affecting daily life as occurred due to the fusion of bones.
What are the tips for home management of Ankylosing Spondylitis?
Home management includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Exercise programs need to be customized for each individual. Swimming and aerobic exercises are best suited for these individuals. Patients with advanced ankylosis need workplace adjustments to suit their limited motion in the spine.
What are the tests which aid in the diagnosis of Ankylosing Spondylitis?
The diagnosis of ankylosing spondylitis is based on evaluating the patient’s symptoms (as elaborated above), a physical examination, X-ray findings (radiographs), and blood tests. The examination can demonstrate signs of inflammation and a decrease in the range of motion of joint. The flexibility of the low back and/or neck can be decreased. There may be tenderness of the sacroiliac joints of the upper buttocks. Chest expansion with full breathing can be limited because of the rigidity of the chest wall. Severely affected people can have a stooped posture. Signs of ankylosis can be seen on X-rays. The presence of the genetic marker HLA-B27 can be identified by a blood test. Other blood tests including ESR, CRP, Blood counts provide evidence of inflammation in the body.
What are the management options for Ankylosing Spondylitis?
The treatment includes the use of medications to reduce inflammation and/or suppress immunity to stop the progression of the disease, physical therapy, and exercise. Medications, commonly used to decrease pain include aspirin and other nonsteroidal anti-inflammatory drugs. In some people with ankylosing spondylitis, inflammation of joints does not respond to the above and these individuals need the addition of disease-modifying antirheumatic drugs (DMARDs) that suppress the body’s immune system. These medications, such as Sulfasalazine (Azulfidine), may bring about the long-term reduction of inflammation. An alternative to sulfasalazine that is somewhat more effective is methotrexate, which can be administered orally or by injection. Newer, effective medications for spine disease attack a messenger protein of inflammation called tumor necrosis factor (TNF). These TNF-blocking medications include etanercept, infliximab, adalimumab, etc. Oral or injectable corticosteroids are potent anti-inflammatory agents and can effectively control spondylitis and other inflammations in the body. Surgery may be required in severe cases of ankylosis of hips or spine.
What is the role of Spine surgery in Ankylosing Spondylitis?
Signs which may suggest that surgery might me required in Ankylosing Spondylitis include: Inability to lift up the head and look forward due to abnormal fixed flexed position of spine, a fracture through the ankylosis wit compromised stability of spine leading to severe pain un responsive to medications, Presence of neurologic deficits, inability to carry out activities of daily living due to bony ankylosis and severe pain and also a combination of above scenarios. The type of spine surgery recommended is based on the type of presentation. Decompression surgery like laminectomy is required for neurological compression with deficits. Spinal instrumentation is required when stability is compromised due to fracture. Osteotomy which is breaking the bones, with screw fixation is required when the spine is fused in an abnormal position. Spine surgery has become safe with recent advances and availability of modern equipments.
