Ankylosing spondylitis (AS)
Causes and risk factors
It is estimated that about 130 out of 100,000 people have ankylosing spondylitis. Young people are more often affected, and men are 9 times more likely to suffer.
The cause of the disease is still unknown. There is a genetic predisposition, and it is associated with the histocompatibility antigen HLA B27 in more than 95% of cases.
Which are the symptoms?
Usually, symptoms appear with a slow-onset pain in the lumbosacral region. Frequent are localizations in the hips and shoulders, in addition to enteropathies (inflammation of the points of attachment of tendons to the bone.
The most frequent extra-articular manifestations:
· anterior uveitis;
· aortic insufficiency;
· ponytail syndrome.
ponytail syndrome.Loss of flexibility of the lumber spine is an early symptom. Later, the disease can also affect the neck and trunk. Episodes of arthritis occur in the shoulders, thighs, and feet (heel spikes).
In some cases, spondylitis is associated with inflammatory bowel disease.
It is important to start treatment before persistent deformities and stiffness develop. Unfortunately, this often does not happen, as the disease is easily confused with radiculitis or just low back pain.
How is it diagnosed?
Biochemical blood tests can demonstrate elevated ESR, anemia, and the positivity of the HLA-B27 marker. X-ray examinations can also reveal calcifications of the intervertebral ligaments characteristic of this disease.
How is it treated?
First of all, nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed, which, however, do not change the course of the disease, but only affect the symptoms.
Among the basic drugs, sulfasalazine is most often used. More recently, biologics have become available, such as TNF (Tumor Necrosis Factor – TNF inhibitors), which are much more effective in fighting pain and seem to be able to prevent the progression of ankylosis.
Physical therapy is the main therapeutic aid for improving posture and restoring normal motor skills.
Respiratory gymnastics is also important, as the disease can cause severe restrictive respiratory failure. Smoking patients should get rid of the addiction.