Ankylosing Spondylitis (AS), popularly known as "spine rheumatism", is an inflammatory rheumatic disease. It is a progressive, painful, chronic disease that usually occurs in adolescence and early adulthood, most commonly involving the spine. In the advanced stage of the disease, the spine bends forward and the vertebral spaces merge. The pain intensifies. It can also affect the joints between the lower end of the spine and the pelvis, the spine, the muscle ends and ligaments that attach to the bones, and other joints, including the rib cage, shoulder, and hip. In addition to the disease-related complaints of patients with ankylosing spondylitis, problems related to functionality such as a decrease in quality of life and inability to continue social and work life develop in the long term.
What are the Symptoms of Ankylosing Spondylitis?
AS Symptoms often begin in late adolescence or early adulthood. Onset after the age of 40 is rare. It can also start in childhood. It is more common in men. Since it is a systemic disease, involvement can be seen in other organs other than the musculoskeletal system.
Diagnostic criteria of ankylosing spondylitis;
- starting before the age of 40,
- lasting longer than three months,
- clearing with rest and decreasing with movement
- low back, hip, back-neck pain and stiffness,
- hip pain that wakes you up in the middle of the night,
- morning stiffness lasting longer than 30 minutes.
What are the Extramusculoskeletal Involvements in AS?
Although AS is known as an inflammatory disease of the musculoskeletal system, it can also involve other organ systems. Among these, the most common ones are:
- Eye: It can cause recurrent inflammatory attacks called anterior uveitis in the anterior part of the uvea layer of the eye.
- Heart: Aorta may enlarge after inflammation of the aorta, which is the largest artery in the body. . This can lead to dysfunction by distorting the shape of the aortic valve. More rarely, pericardial inflammation and rhythm disturbances can be seen.
- Lung: In some of the AS patients, expansion of the lung during breathing may be restricted due to involvement of the thorax and spine. In addition, in the upper parts of the lung itself, we call it fibrosis. Swelling and tissue loss may develop. Thus, a decrease in lung capacity and respiratory dysfunction may occur.
- Kidneys: In the advanced stages of AS, renal dysfunction may develop due to the accumulation of a protein called amyloid in the kidneys.
- Intestine: Intestines may rarely develop ulcers. . Most of the time, these ulcers do not give any symptoms.
- Nervous System: Patients with AS may experience compression fractures and hunching of the vertebrae due to osteoporosis secondary to inflammation in the spine. In the late period, new bone formations and canal stenosis may develop. Depending on these, due to the pressure on the spinal cord and nerves coming out of the spinal cord, neurological complaints and findings may develop depending on the place of involvement.
How to Diagnose AS?
The disease is insidious It has a prognosis and patients do not have obvious complaints until morning stiffness develops.
Patients usually apply to the physician with complaints of morning stiffness and limitation of movement. Ankylosing spondylitis disease should be considered in the differential diagnosis of young adult male patients presenting with these complaints.
Since AS is genetically inherited, the patient's family history, disease history, and physical examination including tests evaluating the disease-specific range of motion are performed. A clinical diagnosis is made for those who meet the AS diagnostic criteria.
Among the laboratory tests requested after physical examination, the results of HLA-B27 and sacroiliac joint radiography are definitive diagnosis. In some patients, joint spacing can be evaluated in more detail with magnetic resonance imaging.
How is AS Treated?
There is no definitive treatment for AS. The aim of the treatment is to relieve pain and stiffness, to prevent or slow down the long-term permanent disability and related undesirable effects, and to eliminate other systemic involvement. NSAIDs alone may be sufficient in early and mild patients.
Second-line treatments such as sulfasalazine and methotrexate may be beneficial in patients with extravertebral joint involvement. Regional corticosteroid injection can be applied to selected patients.
Anti-tumor necrosis factor therapies (anti-TNF therapies) They are drugs that have an important place in patients for whom NSAIDs and other treatments are not sufficient or cannot be used, and from which patients can benefit significantly. There are forms of these treatments that are administered intravenously or subcutaneously. Treatments should be given in appropriate patients with necessary precautions and close physician follow-up.
Bisphosphonate and other osteoporosis treatments can be considered in the treatment of osteoporosis secondary to inflammation.
Physiotherapy (Physical Therapy): Daily exercises are very important for maintaining good posture, maintaining rib cage stretching and minimizing possible injuries. .
Swimming should be included in the exercise program as it preserves the expansion capacity of the lungs. Stretching exercises such as Pilates help maintain the mobility of the joint ranges. Considering the potential risks of the disease on the chest and lungs, smoking should not be smoked.
Nutrition to Protect Bone Health: Although there is no specific diet defined for AS, a diet that prevents problems that may arise in the long term ensures a high quality of life.
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A diet rich in calcium should be given importance. Men and women aged 18-50 should have a daily calcium intake of 1000 mg. Vitamin D is needed for adequate calcium absorption. Sufficient vitamin D stores should be found in the body by sunbathing or by replacing it if there is a vitamin D deficiency.
Alcohol and caffeinated beverages should be restricted as they accelerate calcium and bone loss. It prevents weight-bearing joints such as the knee from carrying more weight.
Is There a Place for Surgery in the Treatment of AS?
Total hip prosthesis can be applied in patients with severe pain and limitation of movement. Spine surgery can be performed in some advanced deformities. With early diagnosis and appropriate treatment, productive patients' quality of life can be maintained and productive. It can be ensured that they live a life.
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