Diagnosing ankylosing spondylitis can be quite difficult in the early stages or indeed in very mild cases. As back pain is very common and is usually caused by muscle strain.
An x-ray of the spine and sacroiliac joints is taken, as degenerative changes are usually first seen in the sacroiliac joints.
A rheumatologist that specializes in ankylosing spondylitis can usually make an accurate diagnosis very quickly.
Ankylosing Spondylitis Symptoms
The symptoms and severity of ankylosing spondylitis vary from mild to severe back pain, from mild stiffness to loss of mobility. Symptoms may come and go. In the early stages, inflammation of the sacroiliac joints causes hip pain (deep within the buttocks) and lower back and stiffness, especially at night, in the morning, and after periods of inactivity.
Later, the inflammation may spread further up the spine and to other joints. If inflammation occurs in the joints between the ribs and spine, pain may be felt in the chest area. The hips, shoulders, heels or knees are sometimes affected. Sometimes there is inflammation of the eyes. Very rarely, the inflammation may involve the heart.
There may be fatigue, lack of appetite, weight loss, a low-grade fever. In severe cases, the spine sometimes fuses in a stooped over position. However this can be avoided.
Preventing Stooping
Inflammation damages the joints. Scarring of the tissues and extra bone overgrowth can develop as a result of chronic inflammation. Eventually, in some severe cases of ankylosing spondylitis, the ligaments of the spine become fused together by bony overgrowth of the vertebrae this is called ankylosis.
Not all cases of Ankylosing spondylitis reach this stage, but maintaining good posture is essential so that if the spine does fuse the spine will be in a fixed upright position rather than a fixed hunched over position.
Strengthening exercises for the muscles that support the spine and stretching exercises help maintain proper posture. A physical therapist can create a customised exercise program for a patient to follow. Exercise plays a vital role in managing this disease.
Medications Used to Treat Ankylosing Spondylitis
Medications for Ankylosing spondylitis are geared at reducing inflammation.
NSAIDs:
Non-steroidal Anti-Inflammatory Drugs. NSAIDs treat the pain and inflammation. Ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, ) and indomethacin (Indocin) are NSAIDs.
When NSAIDs are not effective enough other medications are often used.
Sulfasalazine, often used for inflammatory bowel disease, also can reduce pain and inflammation in the joints and is sometimes used to treat ankylosing spondylitis.
Immunosuppressive agents:
Drugs that suppress the immune system, such as Azathiprine, or Methotrexate are sometimes used to treat Ankylosing spondylitis. Immunosuppressive agents are used to suppress the inflammatory response by suppressing the immune system.
The immune system seems to be overly sensitive in people with Ankylosing spondylitis and certain cells of the immune system that initiate inflammation may be triggered too easily.
Corticosteroids (such as prednisone) have extremely powerful anti-inflammatory properties and also suppress the immune system. The problem with corticosteroids is that the side effects are severe in long-term use and the person taking them can develop a host of other unwanted problems.
TNF Inhibitors:
One class of drugs, TNF Inhibitors (such as Remicade), has shown a lot of promise in treating ankylosing spondylitis along with other chronic inflammatory diseases. Remicade suppresses inflammation by binding to and neutralizing substances (TNFa) that act as an alarm signal that triggers inflammation. New drugs in this class are being developed.
Remicade infusion contains the active ingredient infliximab, which is a type of medicine called a monoclonal antibody. It works by suppressing part of the immune system and modifying the process of inflammation.
Monoclonal antibodies are manufactured antibodies that are specifically designed to recognise and bind to unique proteins in the body. Infliximab works by binding to and preventing the activity of a specific protein produced by the body, called tumour necrosis factor alpha (TNF alpha). TNF alpha is involved in producing inflammation. It controls the activity of other inflammatory chemicals.
This medicine can compromise the body's ability to fight infections, and cases of tuberculosis (TB) have been seen. For this reason, you should be tested for TB prior to treatment. Tell your doctor immediately if you experience persistent coughing, weight loss or fever, as these can be symptoms of TB. It is important to try and avoid exposure to infections during your treatment. Contact your doctor as soon as possible if you get any symptoms of any infection so that it can be treated without delay. This applies for up to six months after finishing treatment, as this is how long it may take for the medicine to be removed from the body. Be aware that this medicine can mask some of the usual symptoms of infection, such as a high temperature (fever), so it is important to be extra vigilant. If you develop a serious infection, further treatment with this medicine should not be given.
Terry has been involved in General Medicine for over 20 years, he is a keen sports player and still turns out most Saturdays on the Rugby pitch, although his body wishes that he didn't!
Dragged up in Liverpool and supporting the BLUE half of Merseyside. Terry went on to study Medicine and initially serve in HM Forces, serving all over the world and completing just over 15 years service.
Terry launched Back Trouble UK, during 2007, however the Therapist Directory did not go online until January 2008. www.backtrouble.co.uk The main reason that Terry launched the website was so that people in the UK who were suffering from a Back Condition. Would have access to quality, clear, jargon free Back Pain Health Information, and online access to UK Registered Back Pain Practitioners & Therapists promoting non invasive natural treatment options.
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