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Ankylosing Spondylitis is a chronic inflammatory disease that mainly affects the spine and the sacroiliac joints. These joints connect the spine to the pelvis. The long-term inflammation causes new bone formation, leading to stiffness and eventual fusion of the vertebrae.
read more about ankylosing spondylitis ...The underlying mechanism involves autoimmune inflammation. The disease has a strong link to the presence of the HLA-B27 gene, which is found in over 90 percent of people with this disorder. The immune system mistakenly attacks the joints and ligaments of the spine, causing chronic inflammation at the site where tendons and ligaments attach to the bone (enthesitis).
This chronic attack eventually prompts the body to lay down new bone tissue. This process can fuse the vertebrae together, resulting in a stiff, rigid spine. The inflammatory nature of the disease is what differentiates it from mechanical back problems.
Symptoms are associated with chronic pain and stiffness in the lower back and hips. The discomfort is typically worst in the morning and after periods of rest. In contrast to mechanical back pain, the pain usually improves significantly with exercise and activity, which helps with diagnosis.
Over time, the spine can fuse into a forward-curving posture known as a "bamboo spine." This severely restricts mobility and can limit chest expansion. Reduced chest wall movement can result in difficulty breathing, especially during physical exertion.
Diagnosis involves a physical examination and imaging tests like X-rays or MRI to look for changes in the spine and sacroiliac joints. Blood tests are performed to check for inflammatory markers and the presence of the HLA-B27 gene.
Ankylosing Spondylitis impacts eye health because it is a systemic inflammatory disease. The most commonly seen ocular complication is acute anterior uveitis (inflammation inside the front of the eye). This causes sudden, severe eye pain, light sensitivity, and redness. This complication requires immediate treatment with steroid drops to prevent permanent vision loss.
Treatment involves medication and physical therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain and stiffness. Biologic drugs such as TNF inhibitors slow the progression of the disease by targeting the immune system. Physical therapy is also needed to maintain flexibility and posture.
No, the disease is chronic. Early diagnosis and modern biologic treatments can effectively control inflammation and prevent spinal fusion.
No, the disease can affect other joints, the hips, the eyes, and sometimes the heart and lungs.
Yes, the pain is inflammatory. It is characteristically worse when resting, especially in the early morning.
Consult an eye doctor immediately if you have a red, painful eye and sensitivity to light. Ankylosing Spondylitis is highly associated with "Acute Anterior Uveitis." If left untreated, this eye inflammation can lead to permanent vision loss from glaucoma or cataracts.
AAO. Ankylosing Spondylitis and Uveitis (aao.org). 2024.
Mayo Clinic. Ankylosing Spondylitis (mayoclinic.org). 2024.
Cleveland Clinic. Spondyloarthritis (clevelandclinic.org). 2023.
StatPearls. Ankylosing Spondylitis (ncbi.nlm.nih.gov). 2024.