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What is Ankylosing Spondylitis?

Ankylosing means stiffening or joining together and is used to describe the fusion of bones in the spine. Spondylitis means inflammation of the spine - a characteristic feature of AS.

In the early stages of AS most of the pain and stiffness is caused by inflammation. Over time, the proces of spinal inflammation and associated tissue damage may lead to bony overgrowths extending from one vertebra to the next. This may then lead to fusion of part of the spine and sometimes the pelvis. The elasticity of the ligaments and tendions may also be replaced by rigid fused bone, with movement of the spine becoming restricted.

Who gets Ankylosing Spondylitis?

AS affects men approximately three times more than it does women. Symptoms usually develop between the ages of 15 and 45 years. When AS appears in children (usually adolescents), it commonly affects the ankles and feet rather than the spine.

What causes Ankylosing Spondylitis?

Approximately 90 percent of people with AS carry a gene called HLA-B27. The gene on its own does not cause AS. It is thought that a combination of unknown triggers affect the immune system and predispose a person to developing AS.

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How is Ankylosing Spondylitis diagnosed?

The diagnosis of AS is made from an assessment of symptoms, physical examinations, blood tests and X-rays or MRI scans. These will be organised by a Rheumatologist who can explain the result of each test. MRI is a diagnostic technique that produces digital images of internal body tissues using magnetic waves.

Symptoms

An early feature in most people with AS is usually a dull ache felt deep in the buttock region, sometimes spreading out over the buttocks, due to inflammation between the tail bone and the pelvis. However, pain is not always confined to the back; pain at the front of the chest or between the shoulder blades (made worse by coughing and sneezing) is also a common early complaint. Increased pain and stiffness can be experienced after long periods of sitting. Sleep may also be interrupted by early morning pain.

Early diagnosis of AS is important because spinal defomity can be minimised and loss of mobility can be reduced with appropriate management. Although there is currently no cure or prevention for AS, the treatment options have improved in recent years so the disease can be managed positively. For some people symptoms are more persistent, while others have only brief episodes of pain (a flare) with long periods of remission. Most people with AS experience a slow decline of spinal flexibility. People with only minor spinal mobility restriction after 10 years are unlikely to develop major problems with AS in the long-term.

Are other parts of the body affected?

Although AS mainly involves the spine, other areas can be affected. About half of the people ith AS have inflammation of secondary joints causing pain, stiffness and swelling. The large joints (hips and shoulders) are most commonly affected. In some cases the knees, ankles and wrist joints can become inflamed.

Inflammation of the eye can occur in about a third of people with AS. Typical warning signs include eye redness and pain, an intolerance of bright light, and blurry vision - generally in one eye at a time. It is important to treat symptoms early.

Occasionally, AS can result in inflammation of the rib joints making breathing, sneezing, coughing or yawning painful. Developing Osteoporosis is a concern for those with AS. A bone mineral density (BMD) test, to assess the amount of bone tissue in the skeleton, may be required.

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Ankylosing Spondylitis and Sex

As this condition usually begins in early adulthood, sexual and reproductive health is important to consider. Having AS should not interfere with sexual relationships, but inflammation in hip joints and the lower back can make having sex painful and uncomfortable. This may mean that you and your partner need to find ways to cope wtih these challenges. Fatigue and tiredness can also impact on your sexual relationship.

Management of Ankylosing Spondylitis

You are the ultimate manager of your healthcare. A range of self-management techniques will be discussed below. You can also get support and advice from other healthcare professionals including:

• General Practitioner (GP) - helps to coordinate care and arranges referrals to other associated medical professionals;
• Rheumatologist - specialises in diagnosing and treating bone, joint and muscle disorders;
• Physiotherapist - helps with mobility techniques, stretches and exercises that are appropriate to AS, including ways to help manage pain and daily activities;
• Occupationa Therapist - evaluates and designs programmes to accomplish basic daily tasks;
• Podiatrist or Orthotist - provides professional assessment and management of feet, including supply of such things as shock absorbing soles for shoes.

AS support groups are also a valuable resource. People who have similar difficulties can provide empathy and share daily experiences and challenges. To see if there is a support group close to you, click on 'what's on in your area' to find out.

Tips for living with Ankylosing Spondylitis

By managing AS carefully, most usual activities should be achievable. For the best part AS is not a barrier to employment, raising a family or keeping physically active. However, AS affects people differently so learning about the condition and what can be done is vital for self-management.

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Good Posture is vital

Those with AS have a tendency to bend forwards and stoop, but poor posture may further impact negatively on the spine's function. When standing, keep bodyweight balanced and even on both feet with shoulders relaxed (back and down). Keep the back of the neck long, allowing the chin to drop slightly forwards. Do not stand still for too long. When moving ,try to maintain a tall relaxed posture.

Have a good supportive chair when sitting; it should be firm, upright and allow the feet to touch the floor with knees and hips at right angles. Avoid neck strain if working at a desk or computer, by having the screen at eye-level. Back supports, lumbar rolls, wedge cushions and other devices may also help.

Sleep

A good night's sleep is essential for rest and repair of the body. Use a mattress that gives support, but is not too hard and a pillow which fits snugly under the neck supporting the head. Sleep in a position that is most comfortable, but if on the side, avoid a lot of bending at the hips and knees. Pillows and other supports may be useful but avoid using them all the time as they may encourage muscle shortening, and try not to put pillows under your knees. A few simple stretching exercises at night before going to bed may improve your sleep.

Manage your energy

It is quite common for people with AS to feel tired. Fatigue is a recognised symptom of the condition as the body uses a lot of energy to fight inflammation. Mild anaemia may also be present. This can be managed with medicine, but there are also other ways to cope with the fatigue. Plan and pace daily activities, varying tasks and allowing time to rest and relax. Moderate physical activity is also helpful.

Other resources can make life easier, such as specially designed chairs and supportive cushions, which help maintain correct posture while driving or sitting at a desk. Simple devices are available to make gardening and other activities easier. For more information on these, talk with your healthcare team or an Arthritis Educator.To download our AS brochure, please click here.

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