Identifying Symptoms and Diagnosis of Ankylosing Spondylitis

How to Recognize If You Have Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a form of chronic arthritis primarily affecting the spine and sacroiliac joints. The term combines Greek roots: "ankylose" meaning stiffness, "spondylos" for vertebra, and "itis" indicating inflammation. It causes long-term inflammation of the joints, leading to pain and stiffness in the back, hips, shoulders, and other areas. Some patients may also experience eye inflammation or gastrointestinal symptoms.

AS symptoms typically involve persistent joint stiffness that worsens over time. Known as Bekhterev's Disease or Marie–Strümpell Disease, it was first described by physicians Vladimir Bekhterev, Adolph Strümpell, and Pierre Marie in the late 1800s. The condition is autoimmune or autoinflammatory, with unknown exact causes but linked to genetics and environment. Over 90% of affected individuals carry the HLA-B27 gene marker.

Young men are more frequently impacted than women. Diagnosis involves imaging and blood tests, but it can be challenging because specific antibodies like Rheumatoid Factor are absent. While there is no cure, symptoms can be managed with medications such as NSAIDs, steroids, DMARDs, and biologic therapies, along with physical exercises. Early symptoms include lower back stiffness, dull pain in the hips and buttocks, especially in the mornings, spread to other joints. The disease often progresses between ages 20 and 30, potentially causing reduced chest expansion, spinal immobility, and cardiovascular or respiratory issues due to inflammation. Eye problems like uveitis and inflammation of other organs can also occur.

There are two main types:

• Radiographic axial spondyloarthritis—Detectable through characteristic changes on X-ray of the sacroiliac joints and spine.
• Non-radiographic axial spondyloarthritis—More difficult to diagnose early, often relying on symptoms and biomarkers. Diagnostic criteria include history of joint inflammation, family history, presence of HLA-B27, response to NSAIDs, and inflammation indicators like CRP. MRI scans can reveal early joint inflammation, while blood tests may show elevated ESR and CRP. Genetic testing for HLA-B27 helps assess risk but isn't definitive. The BASDAI index measures disease activity, and physical tests like Schober’s assess lumbar spine flexibility.