What is Ankylosing Spondylitis?

Written by Na Hong Wei
Orthopedics
Updated on September 23, 2024
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Ankylosing Spondylitis (AS), where "A" stands for fusion and "S" for spine, refers to the condition where the bones and joints of the spine are fused together. Ankylosing Spondylitis is defined as a chronic inflammatory disease primarily affecting the axial skeleton and major limb joints. It is characterized by fibrosis and ossification of the intervertebral discs’ annulus fibrosus and nearby connective tissues, as well as ankylosis (stiffening) of the joints. It presents as a sterile inflammation occurring in the spine. However, it is not solely limited to the spine as it also involves the axial bones and major limb joints. The pathological hallmark of the disease includes inflammation mainly at the sacroiliac joints and points of attachment to the spine, leading to joint stiffness and calcification of the spinal ligaments and joints. The disease progression begins at the sacroiliac joint, spreading upwards through the entirety of the spine, and eventually stops at the cervical vertebrae. Symptoms start with pain in the early stages, followed by restricted mobility in the intermediate phase, and ultimately leading to deformities of the abdomen and back, culminating in severe hunchback. The exact cause of Ankylosing Spondylitis remains unclear, with various theories proposed but none universally accepted. Additionally, it is categorized under rheumatologic and immunologic disorders.

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Written by Li Jing
Rheumatology
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What injections are used for ankylosing spondylitis?

Firstly, ankylosing spondylitis is an autoimmune disease primarily characterized by the destruction of axial joints, a chronic condition that can also manifest peripheral joint lesions. Currently, there are no definitive cures, meaning long-term medication is necessary to alleviate symptoms, control disease progression, delay joint deformity, reduce disability, and improve quality of life. This constitutes the overall goal of treatment. The preferred treatments are non-steroidal anti-inflammatory drugs (NSAIDs) and biologic agents. However, before using biologic agents, it is essential to complete routine blood tests, erythrocyte sedimentation rate, C-reactive protein, screenings for infectious diseases, and tuberculosis. After excluding infections, tuberculosis, and tumors, biologic agents can be administered. During the use of biologic agents, there is a risk of reduced immunity, making it easy to contract infections. Therefore, it is important to avoid getting cold, overwork, and to regularly recheck routine blood parameters, liver, and kidney functions.

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Written by Li Jing
Rheumatology
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What should I do in the late stage of ankylosing spondylitis?

Firstly, ankylosing spondylitis is an autoimmune disease primarily affecting the axial joints, but it can also present with extra-articular manifestations. Severe cases can lead to ankylosis and deformities of the spine, which are complications of late-stage ankylosing spondylitis. At this stage, surgery is needed to manage the activity of the disease. If the activity of the disease is not controlled, even joint replacement can still lead to the progression of the disease and further damage to the joint structures. For severe disabling deformities, spinal orthopedic surgery can be considered, and spinal surgery is required when an acute fracture occurs.

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Written by Li Jing
Rheumatology
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What causes ankylosing spondylitis?

Ankylosing spondylitis is primarily an autoimmune disease affecting the axial joints, which may also manifest with extra-articular symptoms. In severe cases, deformities and stiffening of the spine can occur. The cause of the disease is attributed to the interactive effects of genetics and environmental factors, making it a multi-gene inherited disorder. However, for some individuals, it may also be related to infections such as Ureaplasma urealyticum, Shigella, Salmonella, and Escherichia coli in the urinary and genital tracts. These pathogens trigger the body's inflammatory immune response, resulting in tissue damage and contributing to the onset and progression of the disease. There is a notable familial aggregation in the occurrence of this disease.

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Written by Li Jing
Rheumatology
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Does ankylosing spondylitis have a genetic component?

Ankylosing spondylitis is an autoimmune disease primarily affecting the axial joints. The onset is determined by both genetic and environmental factors, leading to the disease. This means that the disease exhibits a significant familial aggregation and genetic predisposition. If the parents have it, the incidence in their children is much higher than in others. However, it is definitely not a genetic disease; it just has familial clustering and genetic tendencies. If symptoms like stiffness in the neck or pain in the lower back intensify when at rest and decrease after activity, it is essential to use CT or MRI scans and test for HLA-B27 to check for damage or narrowing in the sacroiliac joints. Early diagnosis and early treatment are crucial to improve the prognosis of the condition.

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Written by Li Jing
Rheumatology
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How to exercise with ankylosing spondylitis?

Once diagnosed with ankylosing spondylitis, after ruling out contraindications such as hepatitis B infection and tuberculosis, it is necessary to administer standard medications to improve rheumatic conditions. At the same time, it is necessary to develop good living habits, such as abstaining from alcohol, quitting smoking, and avoiding carbonated drinks and coffee, as these can exacerbate osteoporosis. Secondly, it is important to exercise regularly; one can walk slowly, run, or swim. Swimming is the best form of exercise for patients with ankylosing spondylitis as it can enhance the coordination of limb muscles while also delaying joint wear. Thirdly, it is important to maintain good posture and sleep on a hard bed.