OrthoNeuroSpine & Pain Institute

Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammation, accompanied by increasing stiffening of the spine.

Back pain, especially at night or early in the morning. Stretching and walking often relieve the discomfort. Also, movement helps affected people with ankylosing spondylitis in most cases.

What remains is the fatigue and the feeling of being less mobile. To be stiff. For some months the patients endure the complaints - then they finally visit a doctor.

Ankylosing spondylitis is a non-infectious inflammation of the spine and joints and is a member of the rheumatoid family of diseases. The umbrella term for these conditions is "spondylarthropathies".

What is ankylosing spondylitis?

Ankylosing spondylitis (formerly known as Bechterew's disease) is a chronic inflammatory, seronegative systemic disease ("spondylarthropathy") primarily affecting the axial skeleton in areas such as the spine, the sacroiliac joint, pubic symphisis, small vertebral joints and other joints. Internal organs, including the eyes, cardiovascular system, lungs and bowel may also be affected, though this does not necessarily occur. The onset of the disease occurs between the ages of 15 and 40. Its prevalence in Europe is roughly 1 %. There is a genetic predisposition (90 % of patients test positive for the hereditary factor HLA-B27).

What causes the ankylosing spondylitis?

The causes of ankylosing spondylitis have not yet been found. Likewise, the connection to HLA-B27 has not been clarified as of yet. The possible triggers for ankylosing spondylitis being discussed are: Klebsiellen, shigellas, yersinias, chlamydias or salmonellas.

What are the symptoms of ankylosing spondylitis?

By inflammation of the tendons, patients feel like they are getting stiff and immobile. The lower back hurts.

During the flare-up (active) phase, "inflammatory back pain" is especially prominent, particularly in the form of deep back pain. It manifests as nightly pain in the spine and ribcage (chest pain) that improves with movement, an increase in stiffness and a restriction in ribcage mobility. Arthritis may also develop, an abacterial (not caused by bacteria) inflammation of the joints, especially in the shoulders and wrists and less often in the trunk. The sites where tendons insert into bones (enthesopathies) may also be affected: This manifests as pain in the area where tendons insert into bone and is often associated with restricted mobility and morning stiffness. This is seen around joints, at cartilage-bone junctions, and in structures away from the joints, including the pelvis, thigh, lower leg, and heel.

Ankylosing spondylitis. Symptoms in advanced stage

After months or years, the skeleton of the patient changes. The spine ossifies and bends. It forms a hump.

Signs of inflammation and stiffness in the lumbar and cervical spines (lower back and neck) become more prominent in the advanced phase of ankylosing spondylitis.

Symptoms when the inner organs are affected.

The following symptoms may occur when the inner organs are affected:

• Heart involvement
• Aortic insufficiency, AV conduction defects (dysrhythmias)
• Lung involvement: Restrictive pulmonary disease, pulmonary fibrosis (excessive connective tissue in the superior lobes of the lungs)
• Eye involvement: Iritis, iridocyclitis
• Intestinal involvement: Colitis