What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a common rheumatic, autoimmune disease that is rarely heard of. Lack of awareness is attributed to a wide array of autoimmune complications, instigated by the disease process, that compromise much of the body.  Lack of disease awareness results in sufferers diagnoses to be delayed by an average of 6-11 years.

It is time the 2.7 million American’s living with AS are publicly understood.  This type of disease is commonly referred to as an ‘invisible illness’. On the surface, nobody can physically see the disability. Although under the skin, one is contending for energy, overwhelmed by pain, and is encountering a continuous whirlwind of constantly changing symptoms. Victims of AS may present new symptoms at any given time, that may impair their ability to fulfill personal responsibilities. Most effected by the disease adapt to a life of chronic illness, and strive to maintain a highly functioning lifestyle. No one can see the dishevelment underneath the skin. As well as lacking physical evidence, lab results can be just as inclusive. The entire scenario makes it difficult for one to seek out health care providers that recognize the entirety of the disease.

Ankylosing spondylitis is classified as a seronegative spondyloarthropathy; a type of arthritis where inflammation markers are not elevated in the blood. Although the individual will display characteristics of chronic arthritis such as swelling, redness and cracking of joints, and brittle bones.

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Image from http://brainimmune.com/stress-and-rheumatic-diseases/

AS is a chronic, aggressive form of arthritis, primary effecting the spine. Onset of symptoms usually occur during young adulthood, symptoms vary in severity depending on the individual.  No two cases of AS present themselves the same. Severe cases may result in a curvature or hunch in the spine. This is caused by a repetitive process of bones in the spine breaking then calcifying together over time. Calcification, also known as fusing of the spine, typically starts at the base of the spine and the neck, and works its way inwards. Curvatures in the spine due to this process are more often visible in elderly patients. Calcification may also occur in the ribs, restricting lung expansion. Supposedly elderly victims are in less pain because the spine has healed thick, and fused together, no longer breaking, although mobility is significantly impaired. Severer cases may include new bone growth. Commonly recognized symptoms of AS include; morning stiffness, back pain, and inflammation of the sacroiliac joints (SI joints). Overtime complications may occur in smaller joints such as, hands, shoulders, knees, ankles, and jaw. Many also experience gastrointestinal (GI) complications.

Often, one with AS will receive other diagnosis on top of the disease. Most commonly, ulcerative colitis, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), uveitis, or experience heart complications. Some people experience periods of remission, where some symptoms reside for weeks, months, even years. A flare of symptoms may be temporarily or permanently debilitating and demobilizing. From personal experiences with the disease, the last six years of illness I experienced two major flares which altered my memory, speech, and concentration. It was also to blame for hand and leg tremors, weakness, hives, chronic GI complications, facial pain, migraines, dry eyes, and a compromised immune system.  Each flare presented itself differently. My symptoms vary on a daily, hourly, and even by the minute basis. During flares of symptoms, one is known to experience an increase of pain and stiffness usually in the back, neck, shoulders, SI joints, and knees.  Muscle tenderness, cramping in legs, back, feet, and hands, chronic fatigue and weakness are also common complaints.

The cause of ankylosing spondylitis is unclear. Many diagnosed with the disease have a history of GI bleeding. Chronic GI infections are a main suspect in prompting the disease prominence. It is also believed the cause may be from environmental factors.  There is no definitive testing for AS. For many patients, diagnosis is confirmed by testing positive for the gene HLA-B27, although, you can have the disease without having gene. It is also normal to test positive for the gene without ever experiencing the disease onset. Fusing of the spine is not evident in every case, and is more likely to occur in men than women. More often than men, women are diagnosed by evidence of chronic inflammation of the SI joints that is visible via X-ray.

I’m sure that it has become evident, after reading a little about ankylosing spondylitis, why diagnosing the condition could be complicated. There are many aspects of the disease that are also common for other conditions. It’s difficult to pin point a cause when an individual’s list of conditions is effecting their entire body. When one hears rheumatic disease, the collection of autoimmune complications may not immediately come to mind. Complaints can be so broad that care providers may neglect the correlation between them and the disease process. Physicians can learn from patient’s personal encounters to collaborate a better understanding of the disease process.

There is no cure for AS. Anti-TNF inhibitors are a common classification of treatment drugs that slow the process of joint destruction, reduce inflammation, improve skin and GI issues. Some Anti-TNF inhibitors include, Humira, Methotrexate, and Enbrel.  On average these treatment medications typically improve one’s condition by 20%. They also come with an endless list of dangerous side effects. Some side effects include rare cancers. The drugs also compromise the immune system; limiting the body’s ability to protect itself against infection.  There has been scarce research and clinical studies performed on these drugs, many are too new to determine long term affects.

Diet modification, daily exercise, time management, and healthy sleep hygiene are natural ways to manage symptoms. Elimination of all processed foods, carbs, sugars, acidic fruits and vegetables, gluten, dairy, and grains sooth GI complications, reduce body stiffness, and inflammation. Diet modification may also clear up undiagnosed skin conditions such as rashes and sensitivity.  Diet restrictions may improve related conditions such as concentration, chronic fatigue, nausea, and have the ability to increase appetite. For some, altering their diet resulted in remission of pain and symptoms. Implementing a non-strenuous daily exercise/stretch regimen to ones daily routine will enable the building of core muscles; enhancing balance, strength, endurance, and range of motion. Exercise releases endorphins; naturally enhancing one’s mood. When routinely practiced pain, stiffness, cracking joints, and overall quality of life will improve. Staying active throughout the day, balancing out tasks with set time for rest, are a couple ways one can avoid burnout and better manage pain and symptoms.