- Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic spinal inflammation (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis leads to loss of mobility of the spine.
- Ankylosing spondylitis is also a systemic rheumatic disease, meaning it can affect other tissues throughout the body. Accordingly, it can cause inflammation in or injury to other joints away from the spine, as well as other organs, such as the eyes, heart, lungs, and kidneys.
- Ankylosing spondylitis is 2-3 times more common in males than in females. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. The most common age of onset of symptoms is in the second and third decades of life.
- Genetically inherited, born with the HLA-B27 gene.
- Chronic tissue inflammation resulting from the continued activation of the body’s own immune system in the absence of active infection is the hallmark of an inflammatory autoimmune disease.
- Inflammation of the spine, joints, and other organs.
- Pain and morning stiffness of the spine and sacral areas with or without accompanying inflammation in other joints, tendons, and organs.
- Expansion of the chest with full breathing can be limited because of rigidity of the chest wall.
- Severely affected persons can have a stooped posture.Inflammation of the spine causes pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens over months. Occasionally, the onset is rapid and intense. The symptoms of pain and stiffness are often worse in the morning, or after prolonged periods of inactivity.Patients who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine (ankylosis). These fused spines are particularly brittle and vulnerable to breakage (fracture) when involved in trauma, such as motor vehicle accidents. A sudden onset of pain and mobility in the spinal area of these patients can indicate bone breakage (fracture)..Chronic spondylitis and ankylosis cause forward curvature of the upper torso (thoracic spine), limiting breathing capacity. Spondylitis can also affect areas where ribs attach to the upper spine, further limiting lung capacity. Ankylosing spondylitis can cause inflammation and scarring of the lungs, causing coughing and shortness of breath, especially with exercise and infections. Therefore, breathing difficulty can be a serious complication of ankylosing spondylitis.
- Patient’s symptoms
- physical examination
- x-ray finding
- blood tests
- Tests for Rheumatoid factor and antinuclear antibodies
- pulmonary function studies
The treatment of ankylosing spondylitis involves the use of medications to reduce inflammation and/or suppress immunity, physical therapy, and exercise.
Medications decrease inflammation in the spine, and other joints and organs. Physical therapy and exercise help improve posture, spine mobility and lung capacity.
- Physioline management for ankylosing spondylitis includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion, and stretching exercises to improve spine and joint mobility. Since ankylosis of the spine tends to cause forward curvature, patients are instructed to maintain erect posture as much as possible and to perform back extension exercises. Patients are also advised to sleep on a firm mattress and avoid the use of a pillow in order to prevent spine curvature. Ankylosing spondylitis can involve the areas where the ribs attach to the upper spine as well as the vertebral joints, thus limiting lung breathing capacity. Patients are instructed to maximally expand their chest frequently throughout each day to minimize this limitation.
- Exercise programs are customized for the individual patient. Swimming is preferred, as it avoids jarring impact of the spine.
- Inflammation and diseases in other organs are treated separately.
- Cigarette smoking is strongly discouraged in patients with ankylosing spondylitis, as it can accelerate lung scarring and seriously aggravate breathing difficulties.
- Patients may need to modify their activities of daily living and adjust features of the work-place. .
Exercise Therapy for ankylosing spondylitis
Exercise therapy is considered to be an important overall component in the management of patients with ankylosing spondylitis (AS) and is typically coordinated by a physical therapist. The primary goals of exercise therapy in ankylosing spondylitis include:
- Maintaining or improving mobility of the spinal column and peripheral joints and increasing spinal flexibility.
- Stretching the hip joint to prevent stiffness because stiffness in the hip joint may result in a forward bending position leading to postural problems.
- Stretching muscles which may have become shortened
- Strengthening the muscle groups of the back, legs, and trunk
- Improving posture
- Maintaining chest expansion
- Reducing pain and stiffness
It is advisable to consult with your physical therapist and obtain their recommendations for an individualized exercise regimen that would fit with your health and lifestyle. Considerations of an individualized exercise program include a variety of factors including age, overall health, and certain risk factors.
In addition to exercise therapy, physical therapists may suggest alternative methods of pain relief, including muscle relaxation by means of:
- Transcutaneous electrical nerve stimulation (TENS)
- Heat packs for reducing pain and stiffness or cold packs for reducing swelling
- total body immersion in water (hydrotherapy)
- relaxation therapies
Prognosis for Ankylosing Spondylitis
Ankylosing spondylitis (AS) typically carries a generally favorable prognosis, with little to no effect on mortality unless patients have long standing disease and significant complications. In general, most people who are diagnosed with ankylosing spondylitis do not develop severe functional disabilities and can expect to lead normal, productive lives.
Lifestyle Modifications for Ankylosing Spondylitis
Education about the condition and compliance with treatment are very important for patients with ankylosing spondylitis (AS). In addition to medications and physical activity, learning to make some relatively simple lifestyle modifications may have a significant impact on symptoms of ankylosing spondylitis and quality of life.
Suggestions for lifestyle modifications that may help AS patients better control the symptoms of the condition include:
- Workplace Modifications
- Home Modifications
- Sleep Modifications
- General Lifestyle Modifications
Most patients with ankylosing spondylitis continue to be employed full-time. Improve or modify your work environment for optimum positioning of your spine and good posture. These can be achieved by modifications such as:
- Pay attention to your habitual posture while standing or sitting and make a mental (or written) note to yourself of how to modify it for better spinal alignment.
- Adjust your chair at your desk so that you do not bend forward to work
- Try not to stand in one position for a long time. If you must stand in one position for an extended period of time, try to move as many joints as possible while standing such as wiggling your toes and stretching your shoulders.
At home, modify your behavior and surroundings to maintain good posture and to reduce situations that may exacerbate pain. Suggestions include:
- Every effort should be made to keep the spine straight.
- When sitting for long periods of time (e.g., watching TV, eating a meal, reading), stretch your spine by straightening your posture and pulling your shoulders back
- Try to sit in a chair with a firm seat, an upright and tall back, and armrests to relieve the weight from your spine. Soft chairs and sofas tend to exacerbate back pain and stiffness by being conducive to bad posture.
Some relatively minor modifications may help you get a better nights sleep and reduce the extent of fatigue that you may experience in the daytime. Some helpful suggestions include:
- Sleep in a bed which is firm but not too hard.
- Sleep on one pillow if possible and support the hollow of the neck. Multiple pillows increase the angle of bend in the cervical spine (neck).
- If you need to sleep on your stomach, try to do so without a pillow under your head and let your feet dangle off the end of the bed.
- Try not to sleep in a curled position but rather keep your legs straight
General Lifestyle Modifications
- Take a warm shower or bath in the morning if stiffness is a problem. Some people find it helpful to do stretching exercises while standing under hot water in the shower.
- For specific areas of inflammation, try applying hot packs or ice.
- Avoid wearing a corset or brace or any garment that keeps the spine rigid since it is very important for the patient with AS to move and exercise the spine to relieve or avoid stiffness.
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