Ankylosing Spondylitis – Diagnosis and Treatment
Ankylosing spondylitis is a long-lasting inflammatory disease that mostly affects the spine and sacroiliac joints. It causes pain, stiffness, and swelling mainly in the lower back.
This condition can also affect other joints, such as the hips and shoulders. Over time, inflammation can change the vertebrae, sometimes causing the spine to fuse or curve, which doctors call bamboo spine.
People with this form of arthritis often experience chronic pain, fatigue, and reduced movement. These symptoms can make daily life difficult.
Other symptoms include enthesitis, which is swelling where tendons attach to bones, and dactylitis, or swelling of the fingers and toes. Family history, certain genetic markers, and underlying inflammatory conditions like psoriasis can increase the risk of developing ankylosing spondylitis.
Diagnosis
Scans and Imaging
Doctors use different imaging tests to help spot ankylosing spondylitis. X-rays are often the first test and can show changes in the bones and joints of the spine.
| Imaging Test | What it Shows | When Used |
|---|---|---|
| X-ray | Bone and joint changes | First test, but may not show early disease |
| MRI | Bones and soft tissues | Early detection, if X-ray is unclear |
However, these changes may not appear early on. If X-rays do not provide enough information, doctors may order a magnetic resonance imaging (MRI) scan.
MRI scans use strong magnets and radio waves to take detailed pictures of bones and soft tissues. This type of scan can sometimes find signs of the condition before they show up on an X-ray.
Blood Work and Genetics
Doctors check for signs of inflammation using blood tests. They often use tests for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Higher levels can suggest inflammation, but these markers can be high in many health conditions. Doctors may also test for the HLA-B27 gene.
Blood tests show if a person has this gene. Not everyone with the HLA-B27 gene develops ankylosing spondylitis, and people without the gene can still have the disease.
Additional Details
Doctors usually perform a physical exam to check movement, spine flexibility, and pain points. They may ask the patient to take deep breaths to check for chest expansion.
Diagnosing ankylosing spondylitis can take time because symptoms can develop slowly and testing is not always straightforward.
Treatment
Medicine Choices
Doctors often start treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or celecoxib. These medicines help lower pain and swelling.
People should know that NSAIDs may upset the stomach or cause other side effects. If NSAIDs are not enough, other options include:
- Tumor necrosis factor (TNF) blockers
- Interleukin-17 (IL-17) inhibitors
- Janus kinase (JAK) inhibitors
These treatments can lower disease activity and are available as a shot or pill. Doctors sometimes use corticosteroids as short-term solutions, including direct injections into joints if needed.
Other medications, such as disease-modifying antirheumatic drugs (DMARDs), may help with joint symptoms that do not improve with other treatments.
Physical and Exercise Treatments
Regular physical therapy is a key part of managing ankylosing spondylitis. Physical therapists design safe exercises to keep the spine and joints flexible and strong.
Typical activities include stretching, range-of-motion exercises, and strengthening for the back and core muscles. Therapists also train patients for healthy posture while standing, sitting, and sleeping.
Hydrotherapy, which uses water-based activities, can help some people.
Operations and Special Procedures
Doctors may suggest surgery only if pain is very strong or if the hips or spine are so damaged they need fixing. Types of surgery include:
- Hip replacement for joints that are badly damaged.
- Spinal surgery for severe deformity or nerve problems.
- Minimally invasive techniques or epidural steroid injections for certain cases.
Taking Steps for Self Care
Staying active through regular movement is important. Physical activity can help reduce pain, support flexibility, and maintain good posture.
People should try to keep an upright posture every day. Simple posture exercises in front of a mirror may help. Avoid smoking because it can make breathing harder, especially for those with ankylosing spondylitis.
Coping and Support
Managing ankylosing spondylitis involves both medical care and daily coping skills. Many people find support groups or talking with others who have similar experiences helpful.
Using pain relief strategies, planning regular exercise, and staying in touch with healthcare providers can make a difference. Staying informed and connecting with Healthnile resources can help with treatment planning.
Getting Ready for Your Visit
Steps You Can Take Beforehand
A little preparation helps you get the most from your healthcare appointment. Write down all your symptoms, even if some do not seem related.
Note when each symptom started and whether it has changed over time. Gather key details about your health and daily life, such as recent stress, any changes at home or work, and family health problems.
List all medications, vitamins, and supplements you use, including how much you take and how often. Bring a list of questions to ask your healthcare provider or rheumatologist.
Some useful questions include:
- What might be causing my symptoms?
- Are there other possible reasons for my condition?
- Which tests are needed?
- Is this condition likely to be ongoing?
- What plan of treatment is best?
- Are there other options?
- How will other health issues affect this treatment?
- Are there any limits I need to follow?
- Should I see any other specialists?
Bringing a friend or family member can help you remember what was discussed and offer support if you feel nervous or have questions.
Below is a sample checklist to help you prepare:
| Preparation Checklist |
|---|
| Write down all symptoms and when they began. |
| List stress, life changes, and family health history. |
| Prepare a list of all medications and supplements. |
| Write out questions for your healthcare team. |
| Bring someone with you, if possible. |
Questions Your Provider May Ask
During the visit, your doctor or rheumatologist will gather as much detail as possible. They will ask questions to understand your medical background and current symptoms.
Common questions may include:
- Where do you feel pain?
- How strong is your discomfort?
- Are your symptoms steady or do they come and go?
- Is there anything that makes your pain worse or better?
- What have you tried to relieve symptoms, and did any treatments help?
Being ready to answer these questions helps your health care provider or specialist understand your health. The more information you give, the better they can guide you toward testing, treatment, and resources.
Clear and honest answers help your doctor or rheumatologist find the best plan for you. If you do not understand something, ask for it to be repeated or explained. This visit is a team effort, and your voice matters.
