Spinal Conditions
Ankylosing spondylitis
Ankylosing spondylitis is a painful autoimmune disease that can affect large joints in the body, particularly the spine. It results in inflammation of the vertebrae, which can cause them to fuse over time, leading to a hunched posture and reduced range of movement. It may also accompany eye inflammation and heart problems.
What causes ankylosing spondylitis?
Genetics play a notable role in your likelihood of developing ankylosing spondylitis, with most people affected having the HLA-B27 gene. However, you can still suffer from ankylosing spondylitis without this gene.
The following lifestyle factors may also impact its development but are not known to cause it directly:
- Tobacco use
- Diet
- Physical activity
Symptoms and signs of ankylosing spondylitis
People suffering from ankylosing spondylitis may experience:
- Pain in the lower back and hips (usually beginning in early adulthood)
- Reduced mobility in the spine
- A hunched appearance
- Neck pain
- Fatigue
How is ankylosing spondylitis diagnosed?
There is no single test that can diagnose ankylosing spondylitis. As a result, your GP and Dr Alvin Pun will usually use multiple tests to determine an accurate diagnosis. These may include:
Genetic testing
Blood can be examined for the HLA-B27 gene, which can significantly increase your likelihood of developing ankylosing spondylitis. This gene alone does not indicate the condition, and not having it does not necessarily mean you do not have ankylosing spondylitis.
Blood Tests
Your C-reactive protein levels may be examined for signs of inflammation. However, this alone cannot diagnose ankylosing spondylitis because many conditions can cause inflammation.
Physical examination
Your GP or Dr Alvin Pun may test your spine’s range of motion by asking you to make specific movements. If you find these painful or unable to complete, it may indicate ankylosing spondylitis.
X-rays
These can be used to identify cartilage loss, inflammation, or changes in the spine’s bone structure. In particular, evidence of change in the sacroiliac joints can indicate ankylosing spondylitis.
How is ankylosing spondylitis treated?
The goal of treating ankylosing spondylitis is to reduce symptoms and manage pain, allowing you to continue living normally. You must consult your GP and be reviewed by a rheumatologist. The most common method for this is through nonsurgical treatments. These may include:
- Non-steroidal anti-inflammatory medications (NSAIDs) – drugs such as Nurofen and Advil can help reduce pain and inflammation. This treatment is often the first recommended.
- TNF blockers and IL-17 inhibitors – these medications are administered through injection or an IV line. They work by blocking proteins that cause inflammation and encouraging tissue repair.
- Physical therapy – this may help improve your strength and flexibility to preserve posture and movement. Recommendations may include exercises to improve your range of motion or altering your sleep positions.
Surgery for ankylosing spondylitis may be recommended if conservative treatments fail to alleviate symptoms. Dr Alvin Pun may suggest one of the following surgical management options:
- Sacroiliac joint fusion – this surgical procedure involves joining the sacrum and ilium bones together, effectively removing the sacroiliac joint and reducing pain caused by movement.
- Laminectomy – also known as decompression surgery, may be recommended to relieve pressure on the spinal cord and nerves. This may relieve pain, tingling, and weakness.
