Ankylosing spondylitis is a progressive, painful, rheumatic disease that most commonly involves the spine. Usually the first spinal cord involved is the pelvis. Therefore, in the initial period, stiffness, stiffness and pain are felt especially in the lumbar region. Who gets ankylosing spondylitis? Causes of ankylosing spondylitis Symptoms of ankylosing spondylitis
How is ankylosing spondylitis diagnosed? Ankylosing spondylitis treatment.
Ankylosing Spondylitis, popularly known as spine or waist rheumatism, usually occurs at a young age; It is a painful, inflammatory form of rheumatism that affects the spine and the joint between the spine and hip bone. As a result of inflammation, these two bones join and become a single bone. The sacroiliac joint, that is, the area between the lower part of the spine and the pelvis, is usually affected first. With the progression of the disease over time, it can show its effect throughout the entire spine. Inflammation may occur in the hip, spine, knee, ankle and other joints of the patient, especially the lumbar region, and movement restrictions are observed. Starting from the lower part of the spine to the neck area, all disc edges and ligaments are inflamed and then ossified. As a result, curvature occurs in the upper part of the spine towards the front. The course and severity of this disease, which reduces the quality of life, varies from person to person. Although the majority of patients can continue their lives on their own, in a group of patients whose disease progresses, spine movement may be completely restricted. Although the course of the disease continues with periods of well-being, it is exacerbated by episodes of attacks that develop occasionally. Since it is not a common disease, it is often confused with calcification, herniated disc, and osteoporosis. However, while calcification and osteoporosis are seen in the elderly, this disease is seen in young people.
Who Has Ankylosing Spondylitis?
Ankylosing Spondylitis, a chronic disease, is generally seen 2-3 times more often in men than in women. Ankylosing Spondylitis, in which the genetic factor is quite determinant, is more common in men, and the course of the disease progresses faster. Non-microbial inflammatory rheumatism disease is seen in one of every 200 men and 500 women in our country. This disease, which is seen with inflammation in the hip and knee area after the age of 10 in children, usually begins after the age of 20, but its symptoms do not appear immediately. Inflammation often occurs in the spine, shoulder, pelvis, hips, rib cage, knees, hands and ankles. Although it is not known exactly what causes Ankylosing Spondylitis, the incidence of the disease is much higher in people who carry the HLA-B27 gene, which can be detected by laboratory testing. 80% of people diagnosed with Ankylosing Spondylitis placed in Turkey while carrying the HLA-B27 gene, the rate is 95% in European countries. Therefore, it is a fact that the genetic factor is very important. The incidence rate of people whose first-degree relatives have been diagnosed with this disease is approximately 20%.
Causes of Ankylosing Spondylitis
Although the cause of Ankylosing Spondylitis is not known exactly, it is known that hereditary factors play an important role. People who carry the gene called HLA-B27 are at a considerable risk of developing this disease. However, the presence of this gene alone does not mean that the disease will be seen.
Ankylosing Spondylitis Symptoms
Ankylosing Spondylitis is a disease that starts with the complaint of back and spine pain caused by inflammation in young and adults. These pains, which are mild and unnoticed in the initial period, increase over time. Pain, which is also felt in the back, neck, shoulders and hips, is excessive in the morning or when resting, but decreases during the day when moving. The person feels stiffness for about half an hour after waking up and may feel heel pain when first standing up. This is because the pain potential of the resting joints increases. Pain can wake you up at night. Ankylosing Spondylitis patients may have pain and swelling in the hand and foot, knee, hip, shoulder joints and rib cage. In the later stages of the disease, pain and stiffness may be accompanied by limitation of movement in the spine and forward curvature of the spine due to the bone structures resulting from the fusion of the vertebrae. This situation is generally not seen in women. However, movement restriction can be seen more frequently in the neck area. Apart from the musculoskeletal system, redness and pain in the eye, inflammatory bowel diseases and kidney diseases can also be observed. Although the severity of pain and other complaints varies according to the lifestyle and physical condition of the person, it is extremely important for people who have such complaints for more than 3 months to have a specialist physician check. The main symptoms of Ankylosing Spondylitis can be summarized as follows:
- Low back pain that begins between the ages of 20 and 40
- Back pain and stiffness after long rest and sleep
- Decrease in pain and stiffness during the period when physical movements increase
- Joint pain that will awaken you from sleep
- Feeling restricted in movements
- Complaints lasting more than 3 months
- Spine bending forward
In Ankylosing Spondylitis What Are Non-Musculoskeletal Involvements?
Although ankylosing spondylitis is known as an inflammatory disease of the musculoskeletal system, it may also involve other organ systems. Among them, the most common are:
- Eye: It can cause recurrent inflammatory attacks called anterior uveitis in the anterior part of the eye's uvea.
- Heart: After inflammation of the aorta, the largest artery in the body, the aorta may dilate. This may distort the shape of the aortic valve and cause dysfunction.
More rarely, pericarditis and rhythm disturbances can be seen.
- Lungs: In some patients with AS, expansion of the lungs during breathing may be restricted due to the involvement of the ribcage and spine. In addition, hardening and tissue loss, which we call fibrosis, may develop in the upper parts of the lung itself. Thus, a decrease in lung capacity and respiratory dysfunction can be seen.
- Kidneys: In the advanced stages of AS, kidney dysfunction may develop due to the accumulation of a protein called amyloid in the kidneys.
- Bowel: Occasionally, ulcers may develop in the intestine. Most of the time, these ulcers do not cause symptoms.
- Nervous system: In patients with AS, collapse fractures and humpback may occur in the vertebrae due to osteoporosis secondary to inflammation in the spine. In the late period, new bone formations and canal stenosis may develop. Neurological complaints and symptoms may develop depending on the location of involvement due to the pressure on the nerves originating from the spinal cord and spinal cord.
How Is Ankylosing Spondylitis Diagnosed?
The diagnosis of the disease is made by a specialist rheumatologist. After a comprehensive history of the patient who presented with pain in the waist, shoulder and neck vertebra for more than 3 months, the presence of a family member with Ankylosing Spondylitis is questioned. After the oral examination, physical examination is started. Movement limitation tests are applied in physical examination. Whether the swelling in the chest area is normal during breathing and the condition of the vertebral joints and leg movements are examined. If necessary, radiological imaging and laboratory tests are requested. With all these, the rheumatologist can easily diagnose the disease. Diagnostic methods can be listed as follows:
- The detailed history and genetic background of the patient are questioned.
- Movement limitation is investigated with physical examination and tests.
- Radiological imaging is performed when necessary.
- Required laboratory tests are requested.
Ankylosing Spondylitis Treatment
Ankylosing Spondylitis is a chronic rheumatic disease of unknown cause, seen in 0.9% of the world population and characterized by low back pain. The treatment is primarily arranged by the specialist physician according to the clinical features of the patient such as low back pain and stiffness. First of all, different types of drug therapy are applied to reduce and regress the progression of Ankylosing Spondylitis. Thus, it is tried to ensure that the patient does not lose or regain his mobility. In addition, treatment is applied to reduce inflammation and pain in the spine and joints. Since Ankylosing Spondylitis is a life-long disease with no definite treatment, the aim of physicians with treatment is to reduce complaints and complaints and to increase quality of life. In some patients who do not benefit from painkillers used in drug treatment, anti-TNF and specific agents called biological drugs can be used when deemed necessary by the rheumatologist. In addition to drug treatments, exercise and sports are recommended by the physiotherapist to be directed by your physician, specific to the personal situation of the Ankylosing Spondylitis patient. The aim is to increase the patient's mobility, strength and endurance. Exercise as supportive therapy helps to stop the progression of the disease. These exercises; It can be classified as breathing, shoulder, hip and neck exercises and other personal training. In order to improve muscle flexibility, mobility, improve posture and maintain continuity, joint exercises as well as physical therapy methods are also helpful in relieving pain and stiffness. In addition to the regular use of drug therapy given in the treatment of Ankylosing Spondylitis, exercise should also be performed regularly and regularly. The following should be considered in the exercise program to be made:
- Exercise should not be done during an acute attack.
- If the pain increases during exercise, the program should be changed.
- The aim of the exercise program should be to maintain range of motion and strengthen the muscles.
- The exercise program should be in a way that does not damage the muscles and joints.
- You should not exercise for longer than recommended.
- Sudden and drastic movements should be avoided.
Ankylosing Spondylitis, which occurs at young ages when active life is intense, requires a regular physician examination and a continuous exercise program because it is a life-long and progressive disease. At this point, the most important factor to pay attention to is to adopt an active lifestyle. It should not be forgotten that treating the disease with a holistic treatment approach is the most important factor that ensures success in the disease. Do not neglect to have regular check-ups to prevent this disease, for which early diagnosis and treatment is extremely important.
Is There a Place for Surgery in the Treatment of Ankylosing Spondylitis?
- Total hip prosthesis can be applied in patients with severe pain and limitation of movement. Spine surgery can be performed in some advanced deformities.
- Surgical interventions may also be necessary to eliminate neurological damage due to deformities in the spine and stenosis.
In conclusion, although AS is a chronic disease, with early diagnosis and appropriate treatment, the quality of life of productive patients can be preserved and they can lead a productive life.