Ankylosing spondylitis (AS) is a type of spondyloarthropathy (SpA). SpA are associated with the HLA-B27 gene and a unique feature called enthesitis which refers to inflammation of the sites where ligaments and tendons attach to bones. In AS, the predominant involvement is the spine and sacroiliac joints of the pelvis which fuse and become less flexible and can lead to pain and reduced range of motion.
What causes Ankylosing Spondylitis?
Genetics are a major cause for people who deal with AS, as most have a gene that makes a protein called HLA-B27. There is a higher frequency of this gene in the Northern European population. However, having this gene does not automatically make you have this condition.
What are the symptoms?
AS classically starts in the teens and early 20s in young white men but has been found to be under-recognized in women and people of color. Symptoms of inflammatory back pain involve stiffness and aching pain in the lower mid-back and buttocks area (sacroiliac). This is especially noticeable upon awakening, but symptoms can improve with movement and activity. Some people also have joint pain in their hands and feet, recurrent tendonitis especially in the Achilles tendon or plantar fasciitis, or sausage fingers and toes (dactylitis). AS can also present with extra-articular manifestations such as uveitis (painful red eye) and psoriasis of the skin.
How is it diagnosed?
The Assessment of SpondyloArthritis international Society (ASAS) guidelines are useful classification criteria. In short, the clinical features, checking if the HLA-B27 gene is present and X-rays are helpful in the diagnosis of AS. When the diagnosis is uncertain, an MRI of the pelvis examining the sacroiliac joints is especially helpful.
How is it treated?
Selection of medication to treat AS depends on which body part is affected and the severity of involvement. If the spine or sacroiliac joint is affected and does not respond to physical therapy or non-steroidal anti-inflammatory drugs (NSAIDs), biologic treatment should be initiated.
The goal of treatment is not only to improve symptoms and quality of life but to prevent and reduce erosion, fusion, and permanent damage to the spine and joints. In addition to medications, physical therapy exercises are important in managing symptoms and reducing the risk of progression in all individuals with AS.
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