Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the spine and pelvic joints. It is more common in men than women
It is more common at a young age, and when it starts at an older age, it can be confused with spinal calcification called spondylosis. Inflammation starts from the area where the tendons attach to the bone (enthesis) in the joint areas connecting the spine, pelvis and legs to the spine, therefore the main pathology is enthesopathy. Inflammation may also occur in joints such as knees, ankles and hips. Since the main pathology is in the spine, it causes restriction in spinal movements and the emergence of a hunched posture, which we call kyphosis. However, the severity of the disease varies individually. In some cases, it may occur only as morning stiffness and lower back pain in the spine, in addition to pain in the hip and swelling in the knee, and in others, it may occur as limitation and posture disorder in the entire spine. In fact, there are multiple inflammatory rheumatic diseases that affect the spine. Psoriasis rheumatism, reactive arthritis, spinal involvement of inflammatory bowel diseases (ulcerative colitis and Chron's disease), and Reiter Syndrome also cause spinal findings similar to AS, and are distinguished from each other and from AS by some of their symptoms.
What is the cause of ankylosing spondylitis?
Although studies on its pathogenesis continue, genetics still plays an important role. It has been shown that AS is more common in those with the HLAB27 genetic trait. Symptoms occur when this genetic structure is stimulated by environmental factors and transformed into an active gene region. Among environmental factors, it is mostly triggered by infections.
How is ankylosing spondylitis diagnosed?
In the waist area, especially the sacroiliac joint area. We have lower back pain in the area where the dimples are located just above our hips. People complain of morning stiffness that lasts longer than 1 hour in the morning. When you wake up in the morning, it is very difficult and painful to lean forward, pick up your slippers, and lean over the sink to wash your face. Since the inflammatory response in the body reaches its highest level, especially in the second part of the night (towards the morning), the pain intensity occurs while lying down during this period. The person has difficulty turning from right to left in bed and may even experience pain. He wakes up with. In some people, the chest area is affected. Rib cage movements decrease. Involuntary abdominal breathing occurs because there is pain while breathing. Since the main pathology is in the tendons, the Achilles tendon, which is one of the largest tendon areas of our body, is also affected and heel pain is an important finding. Mouth sores, anterior uveitis in the eyes, bloody diarrhea, skin rashes, and fibrotic changes in the lung bases may be observed. In laboratory tests, inflammation values are high, serology is negative, HLA b27 is positive.
How is Ankylosing Spondylitis Treated?
Early diagnosis It is important to start treatment early and minimize the damage that may occur. In addition to drug treatment, the patient must also actively participate in the treatment of this disease. One needs to pay attention not only to taking medications regularly, but also to many parameters such as being at the appropriate weight, exercising regularly, paying attention to nutrients, sleeping with a single pillow, not smoking, and paying attention to oral care. AS usually progresses in the form of attacks and recovery (silent) periods. During quiet periods, micro-level disease activity may continue and there may be no obvious symptoms. For this reason, it is important not to interrupt the follow-ups and treatment, knowing that AS is a chronic long-term disease, and to plan the treatment under the leadership of Internal Medicine-Rheumatology specialists, especially considering its effect on all systems.
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