Ankylosing Spondylitis

Ankylosing Spondylitis: A Complete Guide to Understanding and Managing This Inflammatory Disease

Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine. While this condition is lifelong, it is entirely possible to effectively manage symptoms and maintain a good quality of life with appropriate treatment. Understanding this disease and knowing how physical activity can help is an essential step toward better symptom control.

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a chronic inflammatory disease of the spine. It belongs to a group of conditions called spondyloarthropathies, which affect the joints of the spine and sometimes other joints in the body. This condition is characterized by phases of inflammation that can, over time, lead to a gradual fusion of the vertebrae if not properly managed.

The term 'ankylosing' refers to ankylosis, which means the fusion of joints. However, with modern treatments and appropriate management, the progression toward this fusion can be significantly slowed or even prevented in many people.

Who is Most at Risk for Ankylosing Spondylitis?

This disease has specific demographic characteristics that set it apart from other back conditions. It typically appears in a person's thirties, and symptoms almost always begin before the age of 40. This distinguishes ankylosing spondylitis from mechanical or degenerative lower back pain, which is more common in older individuals.

Men are two to three times more affected by this disease than women, although the condition can affect both sexes. The chances of having this disease are around 1 to 2% in the general population. The presence of a gene called HLA-B27 significantly increases the risk of developing this condition, although not everyone with this gene will develop the disease.

A family history of ankylosing spondylitis is also a risk factor. If a close family member has the condition, your risk of developing the disease is higher than in the general population.

What are the symptoms of ankylosing spondylitis?

It is important to understand that ankylosing spondylitis does not always cause continuous symptoms. Symptoms can occur in flares throughout life, with periods of remission between inflammatory episodes. This pattern of flare-ups is characteristic of the disease.

Common Symptoms

The most frequent symptoms include lower back pain present for at least three months. This prolonged duration is an important diagnostic criterion. The pain has particular characteristics that distinguish it from other types of back pain.

The pain improves with exercise and worsens with rest. This characteristic is opposite to mechanical pain, which generally worsens with activity. The pain is often present at night and in the morning for the first 30 minutes, then improves during the day with movement. This prolonged morning stiffness is a classic sign of inflammation.

Spinal stiffness can, over time, lead to the development of hyperkyphosis of the spine, meaning a very rounded back. This postural deformity can be prevented or minimized through regular exercises and good inflammation control.

It is common to observe pain in one or both buttocks, corresponding to inflammation of the sacroiliac joints that connect the sacrum to the pelvis. This alternating buttock pain is characteristic of ankylosing spondylitis.

Other possible symptoms

Some individuals may also experience other manifestations of the disease. Pain in several other joints can appear simultaneously without apparent reason. Hips, knees, and shoulders are sometimes affected.

Excessive fatigue is frequently reported by people with ankylosing spondylitis. This fatigue is linked to chronic inflammation and can significantly affect quality of life. Extra-articular manifestations can sometimes occur, such as eye inflammation called uveitis, or gastrointestinal problems.

What are the serious symptoms to watch out for?

The presence of certain signs and symptoms should prompt you to seek urgent medical attention or consult a doctor quickly. These 'red flags' are rare but important to recognize.

Severe weakness or paralysis of one or both legs requires immediate consultation. Similarly, a significant or even complete loss of sensation in one or both legs must be evaluated quickly. A recent loss of balance while walking or new, significant incoordination are also concerning.

New difficulties holding urine or stool, as well as a loss of sensation in the genital areas or when wiping after a bowel movement, can indicate serious nerve compression. These symptoms are medical emergencies.

It is reassuring to know that these severe symptoms are present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves favorably with appropriate treatment.

What are the causes of ankylosing spondylitis?

The precise cause of ankylosing spondylitis remains unknown, although research has identified several contributing factors. There appears to be a significant genetic influence in the development of this disease. The HLA-B27 gene is present in about 90% of affected individuals, although many people carrying this gene never develop the disease.

It is believed that the disease results from an interaction between genetic predisposition and environmental factors, possibly infections or other triggers that abnormally activate the immune system. The immune system then attacks the tissues of the spine, causing the chronic inflammation characteristic of the disease.

This condition is different from others like Forestier's disease, which also causes spinal stiffness but is not inflammatory.

How is ankylosing spondylitis diagnosed?

Diagnosing ankylosing spondylitis involves several complementary factors. The history of symptoms is crucial, especially the inflammatory nature of the pain (worse at rest, better with movement), prolonged morning stiffness, and onset before the age of 40.

A physical examination assesses spinal mobility, checks for tenderness in the sacroiliac joints, and identifies other signs of inflammation. Certain medical imaging tests may be needed to confirm the diagnosis. X-rays or MRI scans of the sacroiliac joints can show signs of inflammation or structural changes.

Blood tests may be performed to look for inflammation markers like C-reactive protein and erythrocyte sedimentation rate, as well as the HLA-B27 gene. However, a negative result for this gene does not rule out the diagnosis.

It's important to note that medical imaging is not relevant in 99% of ordinary back pain cases. For ankylosing spondylitis, tests are indicated when the clinical picture suggests this specific condition.

When should you see a physiotherapist for ankylosing spondylitis?

You should consult a physiotherapist if you experience symptoms as described above, or if your doctor has already ruled out any other causes for your pain. Physiotherapy for lower back pain plays a central role in managing this condition.

You do not need to see a doctor before consulting a physiotherapist. Physiotherapists are primary care professionals who can assess your condition and refer you to other healthcare professionals if necessary. If your condition requires seeing a doctor, your physiotherapist will be able to inform you and provide an appropriate referral.

What physiotherapy treatments are available for ankylosing spondylitis?

Your physiotherapist will first conduct a complete assessment to determine your limitations. This assessment examines several essential elements. Your spinal mobility will be tested to identify segments that move less effectively. The gliding of your nerves will be evaluated to check if they are contributing to your symptoms.

Your postural habits will be observed to identify positions that could contribute to the progression of kyphosis. The quality of your movements will be analyzed to pinpoint inefficient movement patterns. Your strength and stability will be measured to assess your muscles' ability to support your spine.

Based on the results of this assessment, your physiotherapist will use different therapeutic approaches. Joint mobilizations and manipulations of your back and nerve joints help reduce pain and improve movement. These manual techniques help maintain spinal mobility.

Specific exercises will be prescribed for you to do at home. Stabilizing muscle exercises strengthen the deep muscles that support your spine. Extension and thoracic mobility exercises are particularly important for preventing the progression of kyphosis. Strength and muscle endurance exercises maintain overall body function.

Your physiotherapist will also teach you how to properly pace your daily activities and hobbies to optimize disease management. You will receive personalized advice for your postural habits and movements.

It's important to understand that ankylosing spondylitis cannot be cured, as it is a lifelong condition. However, the symptoms associated with the disease can be very well managed or even eliminated with appropriate treatment, even if the disease is still present. Many people with the condition lead active and fulfilling lives.

What can you do at home for ankylosing spondylitis?

The most important advice is not to remain completely immobile for long periods, as you will experience more stiffness and pain afterward. Immobility is particularly detrimental in this inflammatory condition where movement helps reduce pain and maintain mobility.

The best thing to do is to stay active. If you are sedentary, start by taking regular walks and doing back mobility exercises daily, respecting your pain levels. If you are already active, continue with activities that don't cause too much pain. Regular exercise is considered one of the cornerstones of ankylosing spondylitis treatment.

Extension and thoracic mobility exercises are particularly beneficial for counteracting the disease's natural tendency to cause kyphosis. Swimming is often recommended because it provides a full-body workout without stressing the joints. Adapted yoga and Pilates can also be beneficial for maintaining flexibility.

If you don't see any improvement despite your efforts, you should consult a physiotherapist for a professional assessment and a personalized exercise program.

Conditions Associated with Ankylosing Spondylitis

Ankylosing spondylitis can coexist with other conditions. Lumbar osteoarthritis can develop in joints that compensate for fused segments. Lumbar facet syndrome can contribute to pain.

Lumbar disc herniation and lumbar radiculopathy can occur in people with ankylosing spondylitis, although they are less common than in the general population due to spinal rigidity.

The Importance of Exercise in Managing Ankylosing Spondylitis

Regular exercise is absolutely essential in managing ankylosing spondylitis. Unlike other conditions where rest is sometimes recommended, physical activity is a first-line treatment for this disease. Exercise helps maintain spinal mobility, strengthen supporting muscles, reduce pain and stiffness, and improve respiratory function.

A comprehensive exercise program should include stretching and mobility exercises to maintain flexibility, strengthening exercises to support the spine, cardiovascular exercises for overall health, and breathing exercises, as thoracic stiffness can affect lung capacity.

Getting Help for Ankylosing Spondylitis

If you are experiencing back pain with the characteristics described in this article, our physiotherapists can help you understand your condition and develop a personalized exercise program. A comprehensive assessment will identify your specific limitations and create a treatment plan tailored to your needs.

Early and consistent management is essential for maintaining a good quality of life with ankylosing spondylitis. Book an appointment today to start your journey toward better managing your condition.

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