Ankylosing Spondylitis

Cause

Little is known yet about the onset of ankylosing spondylitis. It is suspected that certain bacterial infections in the body, and especially of urinary tract and intestines, may lead to this disease in people who are susceptible to it. In this case, there is a long period between infection and the emergence of the first symptoms. Ankylosing spondylitis is common in people suffering from ulcerative colitis, a chronic inflammatory bowel disease. It is certain that a hereditary factor also plays a role.

Symptoms

Ankylosing spondylitis starts with pain and stiffness, especially in the lower back. The symptoms occur mainly at night and in the morning or when a person has been in the same position for a long time. After the spine, also joints of the shoulder, hip and knees become inflamed. The condition deteriorates and the patient is often tired. At a later stage, the eyes, heart and other organs can also get inflamed. Inflammation of tendon attachments occurs regularly, particularly of the Achilles tendon. In addition to the symptoms above, ankylosing spondylitis can cause intestinal and skin problems.

Diagnosis

The diagnosis of ankylosing spondylitis is often based on the story of the patient and the physical examination. Blood tests can support the diagnosis. The doctor then measures the sedimentation rate of red blood cells and antibodies. At a later stage, damaged joints can be seen on an X-ray. Several other examinations are also possible.

Treatment

No cure is available, but good treatment may slow down the disease and ensure that the patient will continue functioning as well as possible.
With ankylosing spondylitis, simple painkillers or anti-inflammatory painkillers are prescribed. The type of drug depends on the symptoms. Biologicals can also be prescribed; these are drugs that are made up of proteins. In addition to medications, the patient is advised to exercise.
In the case of serious damage to the joints, severe pain and loss of function, the doctor may recommend surgery. That may be surgery to the hip, shoulder or knee. If the spine is badly crooked and this seriously limits the patient, back surgery may be necessary to put the spine straight again. This kind of surgery is done in specialized hospitals.

Prognosis

Ankylosing spondylitis is not curable, but life expectancy of patients is generally normal. Treatment is aimed at relieving pain and stiffness. However, patients can do a lot themselves to positively influence the symptoms and the course of the disease.

Considerations

• Exercise is extremely important for a person suffering from ankylosing spondylitis. It reduces stiffness and strengthens the muscles around the spine. This keeps patients more agile and in good condition and they learn a good posture.
• It's important not to force. Rather exercise a lot with little load than do forced exercises that elicit much pain and thus cause a negative response.
• One way to exercise pleasantly is training in water (not too cold). Thus, it is often possible to link up with specific exercising groups for ankylosing spondylitis patients.
• Specific exercises to train posture are also important. It's obviously of importance that in the final stiffening of the back, there is an acceptable posture. Without posture exercises, stiffening will often occur in a strongly bent posture instead.
• Breathing exercises help to keep the chest supple.
• Quit smoking. Because the chest is eventually to expand limited, breathing should be minimally limited by other affairs.
• Little is known about the effect of diet on rheumatic symptoms. Certain foods seem to help some people with rheumatic conditions. Other foods just seem to worsen the symptoms. But this is not (yet) scientifically proven. A healthy diet is certainly important anyway.
• Avoid or reduce overweight.
• Heat by a bath, shower, sauna or infrared lamp reduces the symptoms. However, this may be less comfortable when a person has inflammations.

Facts

• Bekhterev’s disease is named after the Russian neurologist and psychiatrist Vladimir Bekhterev, who described this rheumatic disease for the first time in 1892.
• The Latin name ankylosing spondylitis literally means ‘an inflammation of the spinal joints with stiffness as a result’.
• The prevalence of ankylosing spondylitis is 0.1%.
• Men are three times more likely to have this disease than women.
• The first symptoms can occur at any age, but usually in people aged 20 to 40 years.