The complicated term “ankylosing spondylitis” gives the impression that the disease is rare. Yet, nearly 1 out of 100 Canadians is affected by it.

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a rheumatological disease that causes inflammation in the joints. Its primary target is the vertebrae and sacroiliac joints in the lower back, but can also affect the neck, shoulders and hips. It is characterized by inflammation that causes the immune system to attack ligaments and tendons attached to the joints.

Following such an attack, the bone erodes at these sites, and the body responds by forming new bone tissue. When this occurs in the spine, the vertebrae begin to fuse together, which explains the pain and loss of mobility typically observed with AS. 

Spontaneous remissions and relapses are generally observed during the course of the disease. However, people affected by it can live normally, especially if sustained medical care is received early on.

Who is at risk of having this disease?

AS impacts up to 1 out of 100 Canadians, affecting three times more men than women. Manifestations usually begin at early adult life (often between 15 and 30 years of age, and rarely after the age of 45) and sets in gradually, over several months.

The exact causes remain unknown for now, but we are getting a better understanding of what causes abnormal responses by the immune system. A gene related to an increased risk of having the disease has been identified. It is involved in nearly 90% of affected individuals.

What are the signs and symptoms?

The lower part of the back (lumbar spine) is generally the first area to be affected. Pain and stiffness are usually exacerbated upon awakening and during periods of physical inactivity.

The upper back (cervical and thoracic vertebrae) are affected next. When bone fusion occurs in the rib cage, breathing can be compromised. Furthermore, bone deterioration increases the risk of fractures.

Other possible symptoms include fatigue, general malaise or weakness, loss of appetite or weight loss, etc.

Inflammation can affect various areas of the body such as the eyes (uveitis), the skin (psoriasis) and the digestive tract (Crohn’s disease or ulcerative colitis). The heart and kidneys are more rarely affected.

What are the treatment options?

There is currently no cure for AS. However, various treatments can help reduce or control symptoms and slow down the progression of this chronic disease. They help to prevent deformation of the spinal column. 

A rheumatologist is a doctor specialized in joint disorders such as AS. Their help is often beneficial and crucial in order to develop a treatment plan that corresponds to the affected person’s specific needs.

Medications

People with AS often have to use prescribed medications.

• Anti-inflammatory drugs are often very effective in easing pain and other inflammation-related symptoms, such as swelling and stiffness.
• Disease-modifying anti-rheumatic drugs (DMARDs) or immunosuppressants are intended to alleviate symptoms and better control the disease by reducing immune system over activity.
• Biological response modifiers (BRMs) are used especially in moderate to severe cases or when the disease does not respond to conventional treatments. They block the activity of certain substances responsible for inflammation.

Other treatments against ankylosing spondylitis are not described in this document. Speak to your doctor or pharmacist about it.

Non-pharmacological measures

Other measures can help to ease symptoms and reduce the inconveniences related to the disease, for instance:

• applying heat (to alleviate muscle stiffness around the joints) or cold (to reduce inflammation) on affected joints
• specific flexibility, endurance and strengthening exercises (on the advice of a physiotherapist)
• occupational therapy, and
• surgery

Lifestyle changes

Lifestyle can have an impact on the well-being of people with AS.

• Physical activity. Staying active generally alleviates symptoms.
• Relaxation techniques. Healthy stress management can make a real difference.
• Smoking cessation. It is recommended to quit smoking to maintain respiratory capacity.
• Moderate alcohol consumption. The effects of alcohol increase the risk of falling or accidents, and consequently, of fractures.
• Sufficient intake of calcium and vitamin D. These nutrients are essential to maintaining good bone health.
• The use of a well-suited pillow. A pillow that is too thick can exacerbate pain and stiffness in the back and at the nape.
• Changes to posture. A physiotherapist can help to improve posture in order to reduce symptoms and prevent deformation of the spinal column.

Speak to your pharmacist for additional information about ankylosing spondylitis and its treatments.