Ankylosing Spondylitis

Spondylitis (pronounced spon-dill-eye-tiss), although difficult to say, is not that rare a disease.  Approximately 1 person in 100 suffers with some form of spondylitis.  The CDC estimates that more than 2,700,000 people have the disease in the United States.

Ankylosing spondylitis (pronounced ank-kih-low-sing spon-dill-eye-tiss), or AS, is a form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. Disease progression can lead to ankylosis — new bone formation in the spine — causing sections of the spine to fuse in a fixed, immobile position.  Other characteristics of AS include:

  • Involvement of the sacroiliac (SI) joints where the spine joins the pelvis
  • Inflammation, pain, and stiffness in other areas of the body
  • Sometimes the eyes can become involved (known as iritis or uveitis)
  • In rare cases the lungs and heart can be affected
Symptoms, Diagnosis & Treatment

Symptoms

  • Variable from person to person and frequently misdiagnosed
  • Family history of AS
  • Lower Back Pain, usually diffuse
  • Mild fever & appetite loss at onset of disease
  • Disease progression involves chronic pain
  • Spreading pain up spine and possibly to ribs, shoulder blades, hips, thighs, and heels
  • Fatigue
  • Comorbidity with Crohn’s or Ulcerative Colitis is common
  • Eye inflammation is common

Diagnosis

  • Most common in 17 – 45 year old’s
  • Persistent pain for at least 3 months
  • Back pain and stiffness worsen with immobility (at night and morning)
  • Physical activity and exercise help moderate pain
  • Inflammation and pain along back, pelvic bones, sacroiliac joints, chest, and heels
  • Blood work including HLA-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may or may not help with diagnosis as no marker is definitive
  • SI Joint involvement (although this can be difficult to detect in early progression)

Treatment

  • Medications
  • Exercise and physical therapy
  • Diet, nutrition and weight loss
  • Practicing good posture
  • Heat/cold therapy to relax muscles and reduce joint pain
  • Stress reducing therapies such as medicine, counseling, yoga, tai chi, meditation, and breathing techniques
  • Posture correcting surgery in severe cases
Medications

Medications that may be prescribed by a doctor for AS include nonsteroidal anti-inflammatory drugs (NSAIDs) as a first line therapy. Other medications include the immunosuppressant drugs Sulfasalazine, Methotrexate, Corticosteroids, and Biologics.  Immunosuppressants work by blocking one or more immune responses thereby providing relief of the condition.

Biologics are produced from living organisms or contain components of living organisms and are the most advanced therapies available.  Unlike the chemical immunosuppressants, their exact structure may not be known but their mode of action is highly researched and tested. They are sometimes referred to as biologic response modifiers because they change the manner of operation of natural biologic intracellular and cellular actions.

Ankylosing Spondylitis drugs that may be prescribed by your doctor include:

NSAIDs

  • Ibuprofen
  • Arthrotec (diclofenac + misoprostol)
  • Aleve (naproxen)
  • Mobic (meloxicam)
  • Indocin (indomethacin)
  • Voltaren (diclofenac)
  • Celebrex (celecoxib)

Chemical Immunosuppressants

  • Corticosteroids
  • Methotrexate
  • Sulfasalazine

TNF Inhibitors (Biologic)

  • Enbrel (etanercept)
  • Humira (adalimumab)
  • Remicade (inifleximab)
  • Simponi (golimumab)
  • Cimzia (certolizumab pegol)

IL-17 Inhibitor (Biologic)

  • Cosyntex (secukinumab)

IL 12/23 Inhibitor (Biologic)

  • Stelara (ustekinumab)
Resources

For more information visit Spondylitis Association of America or the Arthritis Foundation.

To watch videos produced by the Spondylitis Association of America explaining the disease click here. Or if you’ve been diagnosed with AS click here.

To request information from Qualmedica Research about enrolling in a clinical trial check out our Studies Page

NOTE: NOT INTENDED AS MEDICAL ADVICE.  DRUGS FOR THIS CONDITION MAY BE ASSOCIATED WITH UNWANTED SIDE EFFECTS OR ADVERSE REACTIONS.  CONSULT YOUR PHYSICIAN BEFORE TAKING ANY DRUGS FOR THIS CONDITION. 

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