Ankylosing Spondylitis

Anklyosing Spondylitis (AS) is an inflammatory condition which affects the spine, hips, and in some cases the peripheral joints of the body. It is classified in the category of spondyloarthritis. With AS, inflammation attacks the spine and soft tissue causing damage. New bone will occasionally grow around the joints as a response to the inflammation which can lead to fusion of the spine. AS can very commonly be missed when a patient is assessed for spinal pain, and in fact, the diagnosis usually occurs 5-7 years after the development of symptoms. It is estimated that anywhere between 5-14% of chronic back pain may be attributed to a spondyloarthritis. Proper management involves a multidisciplinary approach involving long term physiotherapy in adjunct to consultations with your GP and a rheumatologist. Signs and Symptoms of AS: Because AS is relatively rare, it is important to be aware of the signs and symptoms which may indicate that back pain may in fact be a chronic inflammatory arthritis. Some symptoms of the disease are:
  • Onset of pain in late teens or twenties
  • Pain which has been present for greater than 3 months (Chronic in nature)
  • Sacroiliac joint pain (Either one side or both)
  • Improvement in pain levels with activity
  • Stiffness and lack of mobility through the spine
  • Morning stiffness
  • Disturbed sleeping pattern
  • Presence of HLA-B27 on blood testing
  • Radiographic changes on X-ray and MRI
  • In some conditions, redness or irritation of the eyes
Management of AS: Management of AS is a lifetime commitment, but, if caught early and managed effectively, people with AS can live with minimal symptoms. Management includes:
  • A consistent physiotherapy regimen of manual therapy and a comprehensive stretching and mobilisation program
  • Heat therapy when stiff
  • Medical management through NSAIDS
  • Should pain persist with NSAIDS, progression to Anti-TNF medication
   
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