Ankylosing spondylitis (AS) is a chronic, degenerative disease of the spine that affects 1 out of every 500 people. AS is characterized by painful inflammation of the spinal cord and nerves, which may cause numbness or tingling sensations in different parts of your body. Symptoms vary from person to person, but they are usually severe enough to interfere with daily activities such as walking, climbing stairs or even driving a car.
Symptoms of AS include:
Painful, swollen joints in your arms, legs and trunk. These joint swellings may radiate into the bones around them.
They may become inflamed and painful when you bend or twist your limbs. Your feet, ankles and knees may feel particularly sensitive to pressure or movement. You might experience numbness in these areas too.
Numbness or tingling in your hands, fingers and toes. This numbness may occur at rest, or it may suddenly increase during movements.
When you move your hand, the sensation may change from being ‘cold’ to ‘warm’. Some people report feeling their whole body moving when this happens.
Weakness and fatigue in various parts of your body. You might feel tired all over rather than just one part of it.
Difficulty emptying your bladder completely.
Breathing difficulties, such as shortness of breath when you inhale or have to cough forcefully.
Stiff neck, which is worse in the morning and may be accompanied by headaches.
Heartburn and indigestion, which can lead to heartburn or a ‘feeling of food sticking in your throat’.
Pain or discomfort in different parts of your body that may move around.
Fatigue and flu-like symptoms, which are worse in the morning. These may include a high temperature (fever), aches and pains, and feeling drained of energy (malaise).
Inflammation of the spinal cord and/or sac around the spinal cord, causing pain and stiffness to movement.
Sleep problems, such as difficulty falling asleep, staying asleep and/or disturbed sleep.
Treatments for AS are designed to control the inflammation of the spinal cord and nerves:
Anti-inflammatories, such as ibuprofen, help to control the pain and swelling in your joints. It is important not to exceed the recommended dose when using these drugs, as they have been known to cause stomach ulcers or bleeding.
They also increase the risk of heart attack or stroke if taken in high doses or for a long period of time.
Corticosteroids such as prednisolone can be given by mouth or injected into the body to help control the swelling and pain of joints. These drugs work particularly well in the early stages of AS, but your body can build up a resistance to them over time.
They are also known to increase the risk of infection and can cause elevated blood pressure, elevated glucose levels, weight gain and mood swings.
Immunosuppressants such as azathioprine and methotrexate can be used to help slow down the progress of the disease. These drugs may also be given with an anti-tumor necrosis factor (TNF) that helps the body stop attacking itself.
Side effects of these drugs include nausea, vomiting, headache, fever, diarrhea, abdominal pain and loss of appetite. Newer biologics (such as infliximab, adalimumab and certolizumab) have fewer side effects.
Corticosteroids injected into the spinal canal can be used in the short-term to relieve pain and cool inflammation under the skin (dermatomyositis).
A treatment called plasma exchange can be used to reduce the levels of antibodies in your blood. This is usually only used for a short period of time, however, as there are few long-term benefits and it can sometimes make you feel unwell.
Stem cell transplants have been shown to benefit people with severe AS. They do, however, carry a risk of complications and are normally only carried out in specialist centers.
A combination of the above treatments can be used to manage the disease, and the most suitable choice will be based upon your symptoms and medical history.
Most people with AS will experience periods where their symptoms worsen and periods where they improve. It is important to monitor the condition and adjust your treatment as necessary.
Lifestyle adjustments can also help to relieve the symptoms of AS, such as stopping smoking, losing weight if you are overweight, and taking regular exercise.
If you suffer from severe pain that cannot be managed with over the counter medication, your doctor may suggest a short course of prednisolone (a type of steroid) or possibly an NSAID. These drugs should only be used for short periods and under close supervision.
In some cases, they may be prescribed on a long-term basis.
Can AS be prevented?
There is no known way to prevent the early stages of ankylosing spondylitis (the phase where your back becomes stiff and painful), however taking steps to maintain a healthy weight and engaging in regular exercise can help to minimize the impact that the condition has on your spine. The Arthritis Foundation recommends that adults engage in at least 30 minutes of moderate exercise (such as walking or cycling) on 5 or more days of the week.
The role of bacteria and viruses
Research has shown that there is an association between ankylosing spondylitis and certain types of viruses, mainly the types that cause glandular fever (such as the Epstein-Barr virus). This does not mean that all people with these types of viruses will go on to develop ankylosing spondylitis, only that they are more likely to do so.
Most people who have the types of virus that cause glandular fever will not have any symptoms at all. When they do occur, the symptoms of these viruses are typically very mild.
Glandular fever is rarely serious, and most people will recover within a few weeks and show no lingering effects.
There is also some evidence that bacteria in the gut may play a role in ankylosing spondylitis. Certain types of gut bacteria have been found to be more common in people with ankylosing spondylitis compared to healthy people.
Research is currently ongoing to determine whether changing gut bacteria (known as a faecal microbiota transplant) could be used to treat ankylosing spondylitis and whether some people are more likely to benefit from this than others.
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