Orthopedic Health

Ankylosing Spondylitis

Written by
Dr. Saswati Nanda
and medically reviewed by iCliniq medical review team.

Published on Aug 24, 2016 and last reviewed on Sep 07, 2018   -  3 min read

Abstract

Abstract

This article discusses about the causes, pathology, clinical features, musculoskeletal manifestation, investigation and management of ankylosing spondylitis.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory autoimmune disorder of the spine characterized by pain and stiffness with a variable course. It mainly affects the joints of the spine and sacroiliac joint in the pelvis. As the severity increases, the joints start to fuse with each other resulting in a rigid spine.

Causes:

It is thought to be genetic. The disease is more common with HLA-B27 in their first relatives such as father or mother. HLA-B27 is also present in individuals without ankylosing spondylitis development. Therefore, it is thought that there must be some other associated triggering factor responsible for the disease.

It is often associated with genitourinary or with gastrointestinal infection.

Pathology:

Antigen-antibody reaction triggers the inflammatory process. Inflammation is present at bone-ligament and bone-tendon junctions. There also occurs synovitis of synovial joints of the body, such as sacroiliac joint, hip joint, facet joint, etc. Joint becomes swollen and the movements of joints are limited. Destruction of articular cartilage occurs over time, followed by the subchondral bone formation.

The costovertebral joints are frequently involved with limitation of chest expansion. Inflammation of bone-ligament junctions affect the sacroiliac ligaments, intervertebral joints, symphysis pubis and manubrium sterni. The inflammatory reaction is characterized by cellular infiltration, granulation tissue formation and erosion of the adjacent bones. Granulation tissue is replaced by fibrous tissue, which gets ossified over time leading to ankylosis of the joint.

Ossification of the longitudinal ligament results in syndesmophytes. Syndesmophytes between two adjacent vertebral body bridges limit the movement and as a result the spine becomes stiff like bamboo. And so we call it as bamboo spine.

Clinical Features:

  • Insidious onset of intermittent low back pain and morning stiffness. In the starting, there will not be any pain at rest. The pain will be present only with movements and activities. Pain radiates down the buttock. Gradually, when the disease progresses, one may experience continuous pain at rest or on movement and the stiffness will get increased.
  • Involvement of the synovial joints is characterized by swelling, pain and limitation of movements. Inflammation of bone-ligament or bone-tendon joint (enthesopathy) is characterized by localized pain, tenderness and swelling.
  • It usually involves the insertion of tendon Achilles at the ankle joint. In about 10% of cases the disease starts from the peripheral joints usually hip joint.
  • Asymmetrical polyarthritis may develop. As the disease progress it involves lumbar spine, the lordosis (concavity of lumbar spine) gets obliterated and then kyphosis (convexity of spine) may develop.
  • It may be associated with head forward posture and hip joint flexion deformity. The joint movement limitations further may give rise to disability.
  • Chest expansion will be limited with the involvement of costovertebral joints.
  • Peripheral joints such as shoulder, hip and knee may be involved with effusion, loss of mobility and movements. Pain and tenderness also present.
  • Progressive spinal deformity gives rise to typical kyphotic posture and subluxation of atlanto-occipital or atlanto-axial joint.

Extra Musculoskeletal Manifestations:

  1. It includes ocular inflammation in above one-third of the patients.
  2. Carditis.
  3. Aortic valve disease.
  4. Pulmonary fibrosis.

Investigations:

  1. X-ray - The cardinal sign in the early stage is the erosion of the sacroiliac joint and later periarticular sclerosis develops usually on the iliac side of the joint. Sclerosis will be present in the x-ray.
  2. ESR - Erythrocyte sedimentation rate increases during active stage.
  3. Presence of HLA-B27 in 90% of cases.

Management:

  • In the absence of specific cause, the disease is managed by anti-inflammatory and analgesics. Physiotherapy is very much important in maintaining joint range of motion, prevention of deformity and prevention of muscle wasting.
  • Radiotherapy can also be done to improve the patient's well being and functional activities.
  • There is a variable mode of onset and course of the disease. The patient must be educated properly regarding the onset, course of the disease and prognosis.

Stay healthy and fit with regular exercise and say goodbye to drugs.

To know more about ankylosing spondylitis, consult an ankylosing spondylitis specialist online -->https://www.icliniq.com/ask-a-doctor-online/pain-medicine-physician/ankylosing-spondylitis

Last reviewed at:
07 Sep 2018  -  3 min read

RATING

15

Tags:

Related Questions & Answers


Can HLA B27 positve male with ankylosing spondylitis affect his children?

Query: Hello doctor, I am 26 years, I had a hip resurfacing surgery eight years back. I am an HLA B27 positive, even my father is also positive. I have joint pain since last fourteen years. Now, I wish to know that, if I marry and have children will this pass on to them? What measures should I take to ens...  Read Full »


Dr. Ashaq Hussain Parrey
Rheumatologist

Answer: Hello, Welcome to icliniq.com. About 80 % of people with ankylosing spondylitis have HLA B27 positive and only 1 to 4 % people with positive HLA B27 develop ankylosing spondylitis. That means out of 100 people with positive HLA B27 only one to four can develop ankylosing spondylitis and 96 to 99 a...  Read Full »

The biopsy of my skin rash showed interface dermatitis with mucin. Do I have lupus?

Query: Hello doctor, I am a 43 year old female, and I have had itchy, red, and burning rashes. It all started as a few bumps on my right arm, above my eyebrow, right upper nose area, all over the jaw and chin area, right chest and upper back react badly to the sun, and it is getting worse. I have had a l...  Read Full »


Dr. Naval Mendiratta
Rheumatologist

Answer: Hello, Welcome to icliniq.com. The rashes that you are describing along with the biopsy findings can go in favor of a connective tissue disease. Although, I would like to see the reports in detail, but as you mentioned interface dermatitis, it goes more in favor of lupus over dermatomyositis. But, ...  Read Full »

What is the best treatment for Erb's palsy?

Query: Hi doctor, My daughter has Erbs palsy but we did physiotherapy for three months and the doctor said she is fine but she is still struggling with the hand and this is about six months after the doctor discharged us. Please tell me what should I do.  Read Full »


Dr. Jay Indravadan Patel
Physiotherapist

Answer: Hello, Welcome to icliniq.com. Thank you for providing the brief history of your daughter. I am sorry firstly to hear that your daughter is being diagnosed with Erb's palsy. Well, I would suggest you to continue physiotherapy for atleast three days a week as it will be of good help for her. Usuall...  Read Full »

Popular Articles Most Popular Articles

Do you have a question on Physiotherapy or Ankylosing Spondylitis?

Ask a Doctor Online

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.

Fee:  

 


Disclaimer: All health articles published on this website is not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.