What Is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that affects approximately 1 in every 100 people. It primarily causes inflammation in the spine, usually beginning at the sacroiliac joint, where the lower spine meets the pelvis. Over time, the inflammation between spinal bones (vertebrae) can lead to fusion of vertebrae, resulting in stiffness and limited mobility.
Although the exact cause of ankylosing spondylitis remains unknown, genetic predisposition plays a major role. AS is considered a systemic disease as it may also affect other organs and body systems, not just the joints.
Structural changes in the spine due to AS can lead to postural problems like hunching. In later stages, patients may lose mobility in the neck and lower back. Disease progression and symptom severity can vary from person to person.
Symptoms of Ankylosing Spondylitis
Symptoms of ankylosing spondylitis usually begin between the ages of 20 and 40. In women, symptom onset may occur later, but they typically present before age 40.
One of the earliest signs is lower back pain and stiffness that occurs in the morning or after prolonged inactivity, which improves with movement. Like other rheumatologic diseases such as rheumatoid arthritis, AS is characterized by flares and periods of remission.
Common symptoms include:
- Lower back pain starting before the age of 40
- Morning stiffness and pain after prolonged rest
- Pain and stiffness that lessens with activity but worsens with rest
- Limited flexibility in lower back movements
- Persistent pain lasting more than 3 months
- Muscle pain around the lower back
- Systemic symptoms such as fatigue, loss of appetite, and skin rashes
Who Is at Risk?
AS is an autoimmune disease, meaning the body’s immune system mistakenly attacks its own tissues. While the precise cause is unknown, individuals who carry the HLA-B27 gene are at a higher risk. Around 80% of AS patients in Turkey and 95–99% in Europe carry this gene.
If a first-degree relative has AS, the likelihood of developing the disease increases by approximately 20%. Ankylosing spondylitis is also more common in men than women.
Because early symptoms can be nonspecific, misdiagnosis with conditions like lumbar herniation or fibromyalgia is common in the initial stages.
How Is Ankylosing Spondylitis Diagnosed?
Diagnosis is made by rheumatology specialists based on:
- Medical history
- Physical examination
- Imaging studies
During a physical exam, the doctor evaluates:
- Spinal flexibility
- Joint tenderness
- Range of motion
- Pain points
Imaging:
MRI (Magnetic Resonance Imaging) is the most common imaging tool used to detect inflammation in the sacroiliac joints, a key indicator of AS.
Blood tests:
Markers of inflammation (like CRP or ESR) are usually elevated but are not definitive on their own. Testing for the HLA-B27 gene may support the diagnosis, but its presence is not conclusive.
How Is Ankylosing Spondylitis Treated?
There is currently no cure for AS. The goal of treatment is to:
- Relieve pain and stiffness
- Prevent complications and spinal deformities
- Maintain mobility and quality of life
Medications:
- NSAIDs (non-steroidal anti-inflammatory drugs) are the first line of treatment to reduce pain and inflammation.
- Biologic agents, particularly TNF inhibitors, may be used in patients who do not respond to NSAIDs.
Ankylosing Spondylitis Exercises (Physical Therapy & Movement)
Customized physical therapy programs based on:
- Pain level
- Range of motion
- Stage of the disease
Exercise types include:
- Mobility training
- Stretching
- Joint range of motion exercises
- Strengthening routines
These exercises help:
- Reduce pain
- Improve posture and flexibility
- Enhance independence in daily activities
Breathing Exercises
AS may reduce lung capacity due to inflammation of the joints connecting the ribs to the spine. Respiratory exercises play a crucial role in maintaining lung function.
You can access guided breathing exercises via the MoovBuddy app, track your progress, and improve your respiratory capacity.
Lifestyle Tips for People with Ankylosing Spondylitis
Alongside standard treatments, lifestyle modifications can significantly support symptom management and disease progression.
Key recommendations:
- Follow an anti-inflammatory diet: Avoid processed foods, fried items, and high-sugar meals. Diets like the Mediterranean diet can help reduce inflammation.
- Maintain a healthy weight: Excess weight increases pressure on joints and accelerates bone damage.
- Limit alcohol consumption: Alcohol weakens bones and may increase the risk of osteoporosis, worsening AS.
Quit smoking: Smoking intensifies spinal inflammation and pain. It is strongly recommended to stop all tobacco use.