When you get out of bed in the morning, does your back feel stiff and painful? Does it feel like the pain subsides after a little walking or doing something useful? Many people think that this is just a backache or something that comes from fatigue, but sometimes it can be the beginning of something deeper. Today we are talking about such a condition, namely Ankylosing Spondylitis (AS). Don't worry, the most important thing is to be well-informed about this and seek the right treatment.
What exactly is Ankylosing Spondylitis (AS)?
Simply put, Ankylosing Spondylitis (AS) is a type of arthritis. In this, our body's immune system attacks the joints in our spine. This causes inflammation in the joints of the spine. This often starts at the lowest part of the spine, that is, the joints that connect to the hip bones (sacroiliac joints).
Initially, this pain starts on one side, and after a few weeks or months, it can spread to both sides. Sometimes, this pain can also reach the buttocks. Unlike a normal backache, this pain does not subside with rest, but the most distinctive feature is that it feels a little better when the body is exercised and when walking .
Over time, this inflammation can make you feel very tired all the time. This is because the body uses a lot of energy to fight this inflammation.
What should we do in the early stages?
If you have these symptoms, the first thing you should do is see a rheumatologist, a doctor who specializes in joint diseases. He or she will provide you with a treatment plan that is right for you.
- Painkillers: To control pain and inflammation in the early stages, your doctor may prescribe NSAIDs (Nonsteroidal anti-inflammatory drugs) , such as ibuprofen or naproxen.
- Exercise: Exercise is like medicine for someone with AS. It is part of the treatment plan. With exercise,
- It controls the disease from getting worse.
- Reduces pain and stiffness.
- Helps maintain body flexibility.
- Talk to your physical therapist to develop a safe exercise routine that is right for you.
- Diet: It is very important to adopt an anti-inflammatory diet. Include green leafy vegetables, colorful vegetables (e.g., spinach, tomatoes), broccoli, and cabbage in your diet. Stay away from processed foods that are high in sugar, white flour, unhealthy oils, and artificial ingredients.
- Avoid smoking: If you are a smoker, quit as soon as possible. Smoking can make this condition worse. If necessary, talk to your doctor for help.
How the disease progresses over time (Progression)
AS usually progresses slowly from the lower spine to the neck. Scans like MRI can show how much damage has been done to the spine. These changes may be difficult to detect in the first few years, but they become more apparent over time.
As inflammation increases, it can affect not only the spine but also other parts of the body, especially the areas where tendons and ligaments connect to bones (entheses).
| Other places that may be affected | Description |
|---|---|
| Ribs | Chest pain or difficulty breathing may occur. |
| Shoulders | Pain and limitation of movement in the shoulder joints. |
| Hip joints | Pain when walking and bending. |
| Heels | Pain in the tendon that connects the heel to the sole of the foot. |
Other associated medical conditions
- Eye inflammation: About one-third of AS patients will develop eye inflammation (uveitis or iritis) at some point in their lives. Symptoms include eye pain, redness, tearing, blurred vision, and sensitivity to light. If you experience any of these symptoms, see an eye doctor immediately. If left untreated, vision loss can occur.
- Digestive tract inflammation: About 70% of AS patients develop digestive tract inflammation, but many do not show symptoms. About 10% may develop IBD (Inflammatory Bowel Disease) , such as Crohn's disease or Ulcerative Colitis.
- Skin diseases: About 10% of people may also develop psoriasis.
Treatment as the disease progresses
If regular NSAIDs don't provide relief, your doctor may prescribe a stronger class of medications called biologics . These can be more effective because they directly target the things in our immune system that cause inflammation.
TNF inhibitor drugs (e.g., Adalimumab (Humira), Etanercept (Enbrel), Infliximab (Remicade)) may be given first. If these do not work, IL-17 inhibitor drugs (e.g., Secukinumab (Cosentyx)) may be used. At this point, you may also need the help of eye, gastroenterology, or dermatology specialists.
Advanced stage of the disease
When the disease is very severe, the doctor will tell you that you have "spinal fusion." This means that new bone grows between the vertebrae of the spine and fuses them together. This is called spinal fusion .
When the spine starts to fuse together in this way, the spine loses a lot of its flexibility. Although this happens slowly, sometimes the entire spine can become like a single rod.
This fusion increases the risk of spinal fractures. It can also cause the spine to bend forward and develop a hunched posture . Physical therapy can help control this condition.
In addition, this can affect the joints between the ribs and the spine, and the places where the ribs connect to the breastbone. Then it can be difficult to even take a deep breath. In such cases, you can learn ways to make breathing easier from a respiratory therapist.
Very rarely, damage to the nerves at the base of the spine can cause a serious condition called cauda equina syndrome . It can cause loss of bladder and bowel control, sexual dysfunction, and leg pain and weakness.
But remember, these serious conditions are very rare. If you take the medications prescribed by your doctor and follow his instructions, it is not difficult to avoid such serious conditions. It is important to see a doctor for a check-up even when you are asymptomatic.
When to see a doctor
If you develop any new symptoms or if your symptoms get worse, talk to your doctor right away. Don't delay, especially if someone with AS experiences any of the following symptoms:
| Seek medical advice immediately! | |
|---|---|
| Symptom | Description |
| Difficulty breathing | If you feel chest tightness or difficulty breathing. |
| Vision problems | Eye redness, pain, blurred vision. |
| Chest pain | It is important to make sure it is not a heart attack. |
| Severe back or joint pain | A pain worse than your normal pain. |
| Weight loss without reason | It may be a symptom of another medical condition. |
| Increased back stiffness | If there is a clear decrease in back movement. |
Take-Home Message
- Ankylosing Spondylitis (AS) is not just back pain, it is a type of arthritis that affects the spine.
- It is very important to diagnose the disease at an early stage and see a specialist.
- Exercise is an essential treatment for this disease. Never skip it.
- Take the medicine prescribed by your doctor as prescribed and for the prescribed period. Do not stop taking the medicine just because your symptoms have subsided.
- Avoid smoking completely. Adopt a healthy diet.
- If you develop new symptoms such as eye pain, vision problems, or difficulty breathing, notify your doctor immediately.
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