Ankylosing spondylitis

Introduction
Arthritis refers to the inflammation of the joints characterized by pain and stiffness with
swelling in the joints. There are different types of arthritis. Some forms of arthritis are involved
in the damaging of the bones and joints while some just causes swelling. Ankylosing
spondylitis (AS) is a type of autoimmune disorder which falls under inflammatory arthritis.
Autoimmune disorder refers to the bodily condition in which the immune system to recognize
the cells of the body system and attacks them by destroying it. The immune attack is more
prominent in the joints of the spine ultimately forming pain and stiffness. The first symptoms are
observed during late adolescence or between the ages of 15-30. The sacroiliac joints are affected
and are the region where the spine connects with the pelvis. Under extreme conditions it can
spread to other joints and even the entire spine. As the bones get damaged due to the
inflammation the newly forming bones tend to fuse together making the spine inflexible and stiff.
Stiffness is also observed within the hips and shoulders. Enthesitis also known as the
inflammation of the tendons are also observed in some cases of AS. Back of the heels, bottom of
the feet, breast bone are some of the other parts of the body to which inflammation spreads. This
Autoimmune condition leading to the inflammation of the cells in the eye in AS are called
uveitis or iritis. Hence AS has different symptoms and varies with individuals.
Symptoms of AS cannot be generalized as it varies in individuals. Few symptoms includes

Back pain and stiffness in the mornings lasting for about 30 minutes.
Observed in early adulthood
Can disturb even sleep

Pain at the back of heels, under the feet, hips, pelvic region
Pain along the breastbone
Swelling up of knees and other joints with pain
Inflammation in the eye leasing to redness, blurred vision etc.
Genetic tests positive for AS
Severe pain which extends to the legs

Genetics
The gene involved in AS is the HLA-B27. Heritability of the genes also describes the chance for
getting the disease with the severity of about 62 percent. HLA-B27 is strongly associated with
AS (Khan MA,2008). Other genes involved are IL23R, ERAP1, KIF21B, 2p15, 21q22
1-2% people positive for HLA-B27 are likely to acquire AS.
In patient who are HLA-B27 negative the HLA-B60 and HLA-B39 genes may be active or
positive.
People with a first degree relative sufferring AS have a 15-20% chance of acquiring it (Reveille
JD, 2006)
Half of the disease susceptibility is due to the gene corresponding to the major histocompatibility
complex (MHC)
Ankylosing spondylitis affects men more frequently than women. But the severity if occurred in
women is high. Usually appears during the age of 15- 30.
Statistics shows around 2 percent of the population being affected with AS within the northern
European countries and the lowest among the people of Afro-Caribbean descent.

The ratio of men and women getting affected with AS is 3:1

Prevention methods
A person with genetic history for AS is more likely to develop AS. But the severity can be
reduced and also the chance for acquiring the disease can also be controlled by adopting few
methods.
Physical activity

A physical activity strengthens the joints and the muscles which in turn help in supporting the
joints effectively. Support by the strong muscles reduces the intensity of the pain in the joints
which are damaged by AS. This will also help to improve mobility and fitness of the body.
Different activities and exercises and range of motion help reduce pain and stiffness. Exercising
daily can to a great extent lessen the effects of pain. Stretching exercises also helps to relieve
pain.
Taking hot showers can also reduce the severe pain of the back and often cold packs can be used
to reduce swelling of the knees and joints provided a towel is placed between the bag and body.
Keep weight under control to prevent the damage which can be caused to the lower part of the
body.
Treatment and medications:
Medications involved are mainly to reduce inflammation and also to reduce swelling. These also
give prevention for long term damage to the joints and tissues of the body. Non-Steroidal AntiInflammatory Drugs (NSAIDs) are widely used to reduce pain and inflammation. Similarly

second category of drugs includes Disease Modifying Anti-Rheumatic Drugs (DMARDs) which
are used in combination with (NSAIDs). Likewise in some cases Corticosteroids (steroids) are
administered to patients who suffer AS.
NSAIDs have the side effect of affecting the lining of the stomach which can cause ulcers and
bleeding from stomach.
Corticosteroids: cortisone is one example of corticosteroid which is produced naturally in the
body to fight inflammation. The low level of expressed cortisone decreases the body defense
mechanism. Externally supplying the body with cortisones help reduce the inflammation and
symptoms associated with AS. Steroids function very quickly and hence the patients can attain
relief from pain.
Some people also prefer complimentary therapy with alternative treatment options like
naturopathic medicine, acupuncture etc.
New treatment options
Researchers have recognized few new treatment options for AS patients.
Biologics is one of them which can reduce the severity of the disease.
Biologics: these are the class of medications, which are used to treat inflammation in AS
patients. These are capable of blocking the molecule TNF (tumour necrosis factor) and are
positively seen in controlling pain and swelling. TNF is widely seen in inflamed joints of the
spine. These anti-TNF molecules thus block the TNF molecules and have been recognized as an
effective treatment method. Injections are either given as IV or subcutaneously and the dosage
varies from one individual o another. One side effect is the weakening of the immune system

making the body prone to several infections. So the patient should be cautious enough to reduce
the exposure from infections and infected people.
Similarly COXIBs are the newer class of NSAIDs which reduces the ulcers and bleeding of the
stomach which are observed as side effects of the medicines.

References
Ankylosing spondylitis - adalimumab, etanercept and infliximab; NICE Technology Appraisal,
May 2008
Reveille JD; The genetic basis of ankylosing spondylitis. Curr Opin Rheumatol. 2006
Jul;18(4):332-41.
Khan MA. HLA-B27 and its pathogenic role. J Clin Rheumatol. 2008 Feb;14(1):50-2. doi:
10.1097/RHU.0b013e3181637a38.