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Learn about the symptoms of this rheumatological disease affecting the back joints as well as the medication and non-medication treatments for ankylosing spondylitis.
Ankylosing spondylitis is a rheumatological disease that causes inflammation in the joints. Its primary target is the vertebrae or backbone and more specifically the sacroiliitis, the articulation in the lower back. Ankylosing spondylitis causes inflammation that can manifest itself as red blotches, pain, swelling and/or the sensation of heat in these joints. Inflammation occurs when the immune system (the body’s defense mechanism) attacks the joints or articulations; at certain times it can also attack organs such as the eyes or the heart. People suffering from ankylosing spondylitis feel pain in the back as well as a progressive stiffness, which at times can mean a total loss of movement of the back, when the inflammation causes the vertebrae to fuse together. Ankylosing spondylitis is a chronic illness for which there currently is no cure. Several treatments, however, can reduce the symptoms and effectively control pain to allow a sufferer to lead an active life.
We generally observe remissions and spontaneous relapses during the evolution of this illness. In spite of deformations of the vertebrae, it is important to remember that people can continue to function normally.
The exact cause remains unknown, but we are beginning to better understand what causes the abnormal response of the body’s immune system. We know that a gene linked to an increase in the risk factor for developing the disease can be found in 90% of those afflicted with the illness. The illness affects one in every 100 Canadians and is three times more common in men than in women.
The lower back or lumbar region is the first region of the body affected. The pain and characteristic stiffness of this illness are usually more severe in the morning and during periods of lack of physical activity. The upper portions of the back, including the cervical and thoracic vertebrae, are affected in a subsequent phase where mobility is also lost due to the fusion of vertebrae in certain patients suffering from more severe chronic inflammation. This fusion may also occur at the level of the thoracic cage and cause breathing problems.
As mentioned above, the backbone is not the only area affected by this illness. Inflammation may also attack the joints at the knees and shoulders, organs other than the joints such as the eyes causing uveitis, the skin causing psoriasis and the digestive system causing Crohn’s disease and ulcerative colitis. The heart and kidneys are only rarely affected.
Even though there is no cure for this illness, several types of treatments can help those afflicted with ankylosing spondylitis to maintain a positive attitude, while minimizing the daily impact of the disease. The main objective of treatment is to reduce the pain and stiffness, and slow the progress of the deformation of the backbone. The help of a rheumatologist becomes crucial when it is time to develop a treatment plan tailored to the needs of each patient.
A simple, effective, inexpensive and accessible way to reduce the symptoms associated with spondylitis remains exercise. One must remember that the symptoms are exacerbated by a lack of physical activity. Exercise helps the mobility of joints and alleviates pain. Activities such as walking, swimming and cycling, even just once or twice a week, can improve posture. A physiotherapist can help you determine which type of exercise would be best for you. It should be noted that stiffness caused by the illness can increase the risk of fractures to the backbone in contact sports such as hockey and football.
Heat can also help to reduce joint stiffness and pain. This simple, accessible method inevitably helps patients at one moment or another of their illness by giving their back muscles, severely strained by stiff joints, relaxing relief.
Furthermore, smokers should be encouraged to quit, because it can help to improve their condition.
Medication such as an anti-inflammatory does not change the evolution of the illness, but often allows an individual to effectively control pain and swelling. Several types are available without a prescription, while others are available only with a doctor’s prescription. It is very important to inform your pharmacist before purchasing non-prescription medication because it may be very similar to the medication prescribed by your doctor. Furthermore, in view of recent warnings about anti-inflammatory medications, talk to your doctor and/or pharmacist before using them if you have heart disease or a history of stroke.
Disease-modifying anti-rheumatic drugs (DMARDS)
Antirheumatic modifiers of the disease may be introduced in an attempt to reduce the symptoms among patients affected in peripheral joints such as the shoulders. These modifiers can take up to three months before making a difference. Medications such as methotrexate, sulfasalazine, azathioprine and hydroxychloroquine tend to reduce abnormal activity by the immune system. These medications may also be combined in a further attempt to master the illness. Patients who are prescribed these drugs must persist with their treatment in order to reach the maximum beneficial effects.
Biological response modifiers (BMR)
A new category of medication, the biological response modifiers (MBR), is used especially in cases where active spondylitis does not respond to conventional treatment. The medication blocks the activity of certain substances responsible for the inflammation. The inhibitors of alpha tumorous necrosis (anti-TNF alpha), including adalimumab, infliximab, etanercept and golimumab, constitute an example of this category of medication. Often used for moderate to severe cases of the illness, recourse to this medication often allows one to master the disease when it has proven resistant to other treatments. There are different means and frequencies for administering this medication. Talk to your doctor about your options. Certain medication may also be useful for the treatment of diseases concomitant to ankylosing spondylitis such a Crohn’s disease.
Other treatments for ankylosing spondylitis are not described in this document. Talk them over with your doctor or pharmacist.
In the most severe cases, surgery may be required to replace a severely affected joint or to correct a backbone that is significantly deformed by the illness. This surgery, of course, is not necessary with all patients.
For all questions about ankylosing spondylitis or if you would like advice about treatments and related side effects, talk to your doctor or pharmacist.
You can also contact The Arthritis Society at 1-800-321-1433 or visit the www.arthritis.ca.
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