The term ankylosing spondylitis (AS) is derived from the Greek word ankylos which means ‘bent’ (as a result of joint fusion) and spondylos that means ‘spinal vertebra’. It is a serious chronic disease that causes pain and swelling (inflammation) in the spine or in the joint where the pelvic bone meets the base of the spine.
AS, is a prototype of disease from a group of diseases known as spondyloarthritis (SPA) which consists of inflammatory bowel disease, psoriasis, reiters syndrome. Over time, AS can lead to fusing of the bones of the spine (vertebrae) to impair the person’s movement, which has a debilitating effect on a person’s professional and personal life. AS affects mainly men, less common in women and the disease is also less severe in women.
The hallmark of the disease enthesitis (inflammation at the insertion of tendons, ligaments and muscles to the bone) causing stiffness of the joints due to new bone formation. The spine which is the major joint affected will become very stiff and loses it mobility causing the spine to appear bamboo, known as bamboo spine. Hip joint, knee, ankles, peripheral joints like feet also can be affected causing disfigurement, disability and loss of function. Apart from the joints AS can also affect eyes, lungs, heart and nerves.
Recognising ankylosing spondylitis: Symptoms of AS usually appear between the ages of 15 and 30, with some people over 40 also developing the disease. This is important to note, since AS being a type of arthritis, is mistakenly thought to affect only older people. The early symptoms of AS include chronic back pain and increasing stiffness in the spine particularly in the morning or after a period of inactivity. This is often accompanied by pain in the hips, knees or shoulders and a radiating pain in both buttocks. Some patients may also experience diarrhoea, fever and weight loss as a result of inflammation.
How it is diagnosed: Diagnosing AS requires a careful and comprehensive examination of the patient. Conducting a clinical and physical examination; using a range of imaging tests to check the joints and bones and with blood tests and screening for a genetic marker HLA-B27 which is commonly seen in those with AS.
The ‘diagnosis delay’ and why it occurs: It is true that ankylosing spondylitis is not very common, but I suspect that a large number of people are not diagnosed or end up being misdiagnosed for other conditions. This is because awareness about the disease is very low, as a result of which many people go untreated and develop the full-blown disease. Ankylosing spondylitis takes the longest time to be diagnosed compared to other rheumatological diseases.
Management of AS: In the last 20 years, medicines known as ‘biologic drugs’ have been developed that enable patients to lead near-normal lives but only 50% of the people respond to biologics. This is why we need more awareness about the disease and increased investment in research to find newer therapies for this condition.
Learning to effectively manage AS has shown to stop or slow down the progression of the condition physical exercise has a big role to play in the management of AS. This includes exercises that help stretch different muscles, improve body posture and strengthen.