Ankylosing Spondylitis (AS) is a painful progressive inflammatory arthritis. It mainly affects the spine, but other joints, tendons, ligaments and organs such as the eyes, skin and heart may also be involved.
AS is part of a larger group of related disorders called spondyloarthropathies. This includes Psoriatic Arthritis, Reactive Arthritis, Arthritis associated with inflammatory bowel disease and an undifferentiated arthritis. These conditions have many similarities to AS, but differ in some presentations.
The affects of AS vary from one person to the next. The spine is usually most affected, especially the neck and lower back, with the initial onset often in the sacroiliac joints. Restricted, painful movement is common.
Common symptoms include:
Gradual onset of back pain and stiffness over weeks or months (often in the lower back, buttocks and/or legs)
Interrupted sleep, especially in the early hours of the morning, due to back pain and stiffness.
Early morning stiffness and pain, which improves with movement during the day.
Worsening stiffness and pain after rest.
Persistence of stiffness and pain for more than 3 months
Other symptoms may include weight loss (in the early stages), fever and night sweats.
The symptoms of AS often become apparent in the late teens and twenties. Men, women and children can all have AS, however, it is slightly more common in males (2.5/1)
In the early stages of AS, most of the pain and stiffness is caused by inflammation. This is often acute, sharp, disabling pain – especially when walking, standing on one leg or rolling over in bed. This often makes it very difficult to move and many are frightened of hurting themselves more, so tend to rest and avoid movement. This only makes it worse, and makes the pain last longer. It is important to keep moving as much as possible and resume full activity as soon as possible.
Most people with AS experience episodic flares of spinal pain and a slow decline in spinal flexibility. Repeated bouts of inflammation can lead to bony changes in the spine and the tendons and ligaments which support it. This may lead to joining together of some of the vertebra – fusion of the spine.
In the later stages, limitation of spinal mobility is a greater symptom than the pain, and the pain that is felt is usually of a less severe and more chronic nature.
AS is different in all people. Some people have little or no fusion of their spine, even after many years of having AS, whereas others may have significant changes.
The course of AS is very variable. If your AS is diagnosed early and treated appropriately, you will generally do well.
How your disease progresses over the first 10 years usually gives a guide to how you are likely to do in future years.
If you are diagnosed with AS, it is important to develop a plan to manage the condition successfully. AS can be managed with a combination of medicines and specific exercises to relieve pain, maintain mobility and a correct posture, so that you can continue to do your normal daily activities.
Your GP should send you to a rheumatologist to confirm an accurate diagnosis. The rheumatologist can discuss treatment options such as regular exercise and the use of medicines.
A referral to a physiotherapist with some knowledge of AS is important to help you get the best information about ways to help you manage your pain, your daily activities, posture, sport and recreation. Exercise is essential to the successful management of AS, and a physio can tailor an exercise program to your specific needs, especially including stretching and flexibility exercises and postural strengthening. They can help with mobilisation techniques and other physical and electrical techniques if required.
Hydrotherapy – exercises in the water – is extremely helpful for people with AS. The water gives a greater freedom of movement and helps relieve pain, hence enabling more movement with greater ease. ‘less pain – more gain!’
A psychologist may be helpful to help you and your family to adjust to your diagnosis. Stress has a significant effect on flare-ups of your condition and hence how much pain and disability you feel. Psychologists can help you manage stress, motivate you to exercise and guide and help you to self manage your condition.
Healthcare professionals can provide advice, support and treatment. You are important, as the centre of a health team. Your condition needs to be monitored and reviewed. It is important to keep in contact with your medical support team. Regular visits to your rheumatologist are important to ensure that your disease is under control and that the best medicines are being used safely and appropriately. Regular reviews by your physiotherapist are important to ensure that your exercise program is the best for you at that time, and that deterioration in your mobility is prevented or minimised.
Your needs will vary over time and your healthcare professionals are the best people to assist you to improve your quality of life. Your GP can help you coordinate your care. He/she can assess if you are eligible for a ‘care plan’, which means you can access several physio or other allied health treatments under Medicare.
Most people with AS keep active, keep working and live full lives with sport, recreation and family.
Understanding the disease, and knowing what you can do for yourself, will contribute to successful management of the condition.
Support groups are a valuable resource – providing support, information and social interaction.