Ankylosing Spondylitis
 

The cause of ankylosing spondylitis is unknown, but genes seem to play a role. The disease most often begins between ages 20 and 40, but may begin before age 10. It affects more males than females. Risk factors include:

• Family history of ankylosing spondylitis
   
• Male gender

The disease starts with low back pain that comes and goes.

• Pain and stiffness are worse at night, in the morning, or when you are not active. It may wake you from your sleep.
   
• The pain typically gets better with activity or exercise.
   
• Back pain may begin in the sacroiliac joints (between the pelvis and the spine). Over time, it may involve all or part of the spine.

You may lose motion or mobility in the lower spine. You may not be able to fully expand your chest because the joints between the ribs are involved. Fatigue is also a common symptom.

Other, less common symptoms include:

• Eye inflammation or uveitis
• Heel pain
• Hip pain and stiffness
• Joint pain and joint swelling in the shoulders, knees, and ankles
• Loss of appetite
• Slight fever
• Weight loss

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Corticosteroid therapy or medications to suppress the immune system may also be prescribed. Drugs called TNF-inhibitors which block an inflammatory protein, have been shown to improve the symptoms of ankylosing spondylitis.

Some health care professionals use drugs that block cell growth in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids.

Surgery for Ankylosing Spondylitis

Surgery may be done if pain or joint damage is severe. Exercises can help improve posture and breathing. Lying flat on the back at night can help maintain normal posture.

The majority of patients suffering from ankylosing spondylitis do not need to have surgery; however, surgery may be an option for patients suffering from severe ankylosing spondylitis and spinal deformities related to it, especially in the spine or hip joints. There are two types of surgery that may be an option for severe cases, depending on the patient’s clinical situation and symptoms: joint replacement or osteotomy.

Joint Replacement

For the hip, shoulder and knee problems related to this form of arthritis, joint replacement surgery can allow people to regain the use of joints that have been affected by ankylosing spondylitis. Hip, shoulder and knee replacement are becoming increasingly successful for people with severe pain and limited mobility in those joints.

Osteotomy

Surgical correction of the spine itself is also possible to address pronounced deformities such as a humpback or swayback, or the chin-on-chest posture characteristic of patients with advanced ankylosing spondylitis.

Indications that a patient may benefit from this type of surgery include:

• Severe, unremitting pain that is not sufficiently relieved by non-surgical care
• Neurological deficits
• Spinal instability
• Decreased ability to hold the head up and see horizontally
• Difficulty in completing everyday activities due to spinal deformity

For patients who have not benefited from other forms of treatment, surgery can provide relief from some of the physical and associated emotional difficulties of spinal deformity caused by advanced ankylosing spondylitis. The decision to have surgery can be a difficult one, requiring patients to weigh the risks and benefits carefully.

The course of the disease is unpredictable. Symptoms may come and go at any time. Most people are able to function unless the hips are severely involved.