How do you know if you are suffering from ankylosing spondylitis

Ankylosing spondylitis (AS) is a kind of arthritis whose name is derived from three Greek words- ankylose that means stiff, spondylosis meaning vertebra, and itis which means inflammation. This jointly explains the characteristic of the condition of the joints which causes inflammation of the joints associated with the spine over a long term. These joints could be the one between the spine and the pelvis, shoulder joints, hips, etc. that are often characterized by frequent back pain as a common symptom. Apart from these, Ankylosing spondylitis symptoms related to eyes and bowel may also occur in few patients.

All these Ankylosing spondylitis symptoms are however characterized by stiffness of joints which will worsen with time. This disease is sometimes also referred as Bekhterev Disease, Bechterew’s Disease or Marie–Strümpell Disease named after the neurophysiologists Vladimir Bekhterev, Adolph Strümpell and Pierre Marie who all contributed towards giving adequate descriptions of this disease thereby enabling better diagnosis of AS in the 1890s. This is an autoimmune or autoinflammatory condition whose exact cause is still unclear but can be largely attributed to be a combination of genetics and environmental factors. Studies have shown the existence of a specific leukocyte called HLA-B27 antigen in over 90% of the affected patients.

Young males are relatively more prone to AS than females. Although medical imaging and blood tests will be performed based on the Ankylosing spondylitis symptoms, diagnosis of this condition is very difficult as the tests will not show the presence of any antibodies (RH factor). Due to the absence of any specific antibodies, there is no permanent cure for AS. The Ankylosing spondylitis symptoms can only be reduced and controlled from worsening with the aid of suitable exercises and surgery and medication like NSAIDs, steroids, DMARDs and certain biologic agents.

The earliest signs and Ankylosing spondylitis symptoms may appear gradually as a combination of the stiffness of the lower back along with chronic dull pain in the gluteal region or the lower back, often awakening them in the early hours of the morning due to pain. The pain may also occur in one or both buttocks or the thigh from the sacroiliac joint, in the hips and shoulders and swelling of lower limb joints. These Ankylosing spondylitis symptoms may peak when the patient attains between 20 and 30 years of age. Along with weight loss, fever or fatigue, the disease will eventually lead to chest expansion with a limitation of anterior and lateral flexion, loss of mobility of the spine along with the extension of the lumbar spine. Ankylosing spondylitis symptoms may affect the cardiovascular movement due to inflammation of the arteries, valves thereby causing insufficiency or disturbances in the electrical conduction of the heart. Respiratory system may also be affected due to progressive fibrosis of the upper part of the lungs. Although the pain may be reduced during physical activity, AS may also be accompanied by inflammation and pain irrespective of whether the person is resting or in movement. In worst cases, a patient may suffer from ectasia of the sacral nerve root sheaths. There are cases where AS patients have experienced inflammation of the anterior chamber of the eye leading to pain in the eyes with redness, floaters, and photosensitivity. This can be primarily associated with a combination of AS and uveitis with an inheritance of the HLA-B27 antigen. Several male patients may experience Inflammation of the prostate as well.

Ankylosing spondylitis is of two types:

• Radiographic axial spondyloarthritis – This can be diagnosed with a proper description of radiological changes that occur in the sacroiliac joints and spine.
• Non-radiographic axial spondyloarthritis – The diagnosis of this disease is difficult since there are no direct tests to diagnose in the early forms and has to be done largely based on the symptoms. The likely diagnosis tests are:
• The basic diagnosis: The criteria include a history of joints, heels or tendon-bone inflammation (with C-reactive protein and ESR), family history of axial spondyloarthritis, having biomarker HLA-B27, the patient responds to NSAIDs treatments, inflammation of bowel or eyes (uveitis), etc. If these responses are insufficient, then magnetic resonance imaging (MRI) will be helpful to detect inflammation of the sacroiliac joint.
• Radiographic tests: X–rays can help to identify any erosions and sclerosis in the sacroiliac joints or show bony ankylosis or squaring of vertebrae.
• Blood tests: In cases of acute inflammation, the patient’s blood may sometimes have a high concentration of CRP and ESR.
• Genetic tests: There is a higher risk of AS for those having variations of HLA-B gene but does not suffice a confirmation test. The patients with back pain tested positive for HLA-B27 variant are at 90% possibility of suffering from AS, but it also depends on the ethnicity of the person.
• BASDAI: This is an index used to detect the inflammatory and the activeness of AS which along with positive results of other tests help to establish the presence of AS with a possibility of 4: 10 score.
• Schober’s test: Flexion of the lumbar spine can be measured with this test during a physical examination.