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Spondyloarthritis – Ankylosing Spondylitis

Types, causes, symptoms, complications, diagnosis and treatment

What is Spondyloarthritis? What are the types of Spondyloarthritis?

Spondyloarthritis, also known as spondylitis or spondyloarthropathy, is a group of closely related rheumatic diseases that primarily affect joints and enthesis (ligaments and tendons). It is characterized by inflammatory back pain as well as pain and inflammation of the neck, intestine, pelvis, eyes and large joints in the body.

Spondyloarthritis is an umbrella term which is largely associated with the spine, however, it also includes problems related to inflammation of other areas in the body. The most common conditions of spondyloarthritis are:

  • Ankylosing spondylitis is the inflammation and ankylosis (new bone formation) of the spine resulting in inflammatory back pain.
  • Reactive arthritis is the inflammation of joints, skin, eyes, bladder, genitals and mucous membrane that follows after an infection in the intestine or urinary tract. Usually, the symptoms are not permanent and they subside in 3 to 12 months. In some cases, patients may develop chronic arthritis.
  • Psoriatic arthritis is the inflammation and ankylosis of spondylitis in the spine and small joints in hands and feet with skin-related symptoms of psoriasis.
  • Enteropathic arthritis is characterized by the spine and joint symptoms along with inflammation of the intestine which is associated with inflammatory bowel diseases.
  • Juvenile spondyloarthritis: Children with spondyloarthritis (identified with prominent enthesitis) have more peripheral involvement especially in the lower extremity.
  • Undifferentiated spondyloarthritis: Spondyloarthritis that does not fit into any of the above types are categorized here.

According to the newer SpA classification system, spondyloarthritis is classified into:

  • Axial spondyloarthritis (AxSpA): It is a broad category that includes people with or without characteristic inflammatory changes of the sacroiliac joints (joints linking the lowest part of the spine to the pelvis) in X-ray.
    • – Radiologic AxSpA: Spondylitis wherein the sacroiliac changes are prominent on X-ray. Almost all cases of ankylosing spondylitis belong in this category.
    • – Non-radiologic AxSpA: Spondylitis without characteristic sacroiliac changes on X-ray.
  • Peripheral spondyloarthritis (pSpA): This term covers inflammation in joints and/or tendons outside the spine or sacroiliac joints, such as joints in the hands, wrists, elbows, shoulders, knees, ankles, and feet.
    Spondyloarthritis

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a type of arthritis, which primarily affects the spine and cause inflammatory back pain. The condition also affects the joints in the shoulders, hips, ribs, heels and other joints. It is a systemic disease, which means that it is not just limited to bones and joints. AS causes inflammation of spinal joints (vertebrae) leading to severe and chronic pain, stiffness and discomfort.

“Ankylosis” is the formation of new bone tissue in the spine which causes sections of the spine to fuse in a fixed and immobile position. The spine becomes less flexible over time and results in a hunched forward posture.

What causes ankylosing spondylitis (AS)?

There are no specific known causes for AS, however, genetic factors seem to be involved in over 90% of the people with AS have gene HLA-B27.

What are the signs and symptoms of ankylosing spondylitis?

Early signs and symptoms of ankylosing spondylitis include pain and stiffness, particularly in lower back and hips (sacroiliac joint), especially during early mornings or after long periods of inactivity. The stiffness, inflammation and pain can be seen in other joints of the body. The shoulders, neck, hips, ribs, heels and small joints of hands and feet may be involved.

Systemic features like weight loss, fever, fatigue and inflammation are common.

Enthesitis: Inflammation of ligaments, tendons and capsules attached to the bone, mainly in the spine, sometimes in the back of the heel (Achilles tendon), also, the cartilage between the breastbone and ribs is a common symptom.

What are the risk factors for ankylosing spondylitis?

Some risk factors for ankylosing spondylitis are –

  • Gender: It is less common and less severe in females.
  • Age: as develops in late adolescence to early adulthood with the peak onset in the age range from 20 to 30 years.

What are the complications of ankylosing spondylitis?

Scarring and fusion of vertebrae: The hallmark feature of ankylosing spondylitis is the fusion of bones along the spine over time. In severe cases, as a part of the body’s healing mechanism, new bone is formed to bridge the gap between vertebrae. This scarring tissue eventually fuses the vertebrae, leading to stiffness and forward hunched posture.

The fusion can cause stiff rib cage, making deep breathing difficult for the patient, leading to reduced lung capacity and function.

Compression fractures: The weakened vertebrae can crumble; vertebral fractures can put pressure on the spinal cord and nerves passing through the spine.

Eye inflammation: Painful red eyes, inflammation, severe photophobia (sensitivity to light) or blurred vision.

HeartInflamed aorta and distorted aortic valve, this affects the blood supply to the body.

How is ankylosing spondylitis diagnosed?

The orthopedicians or rheumatologists may be able to diagnose ankylosing spondylitis by:

  • Medical history
  • Physical Examination: It is advised to visit a doctor as soon as early signs and symptoms are apparent. During the physical examination, the doctor would test the range of motion in the spine by asking the patient to bend in different directions. Tenderness, stiffness and new bone formations can be felt by palpation along the spine. The doctor may ask you to deep breathe to check for difficulty in breathing upon chest expansion.
  • In case of inflammation and photo-sensitivity in eyes, an ophthalmologist must be consulted immediately.
  • Imaging Tests:
    • X-rays help the doctor look for changes in bones and joints, though the visible signs of the disease might not be evident in the earlier stages.
    • MRI gives detailed images of bones and soft tissues in the earlier stages of ankylosing spondylitis.
  • Lab Tests:
    • There are no specific lab tests to diagnose ankylosing spondylitis. However, blood tests for markers of inflammation can be done.
    • Tests to check the presence of HLA-B27 gene may be done, though not everyone with defective gene gets affected by the disease, it may be done as a precaution.

How is ankylosing spondylitis treated?

Depending on the signs and symptoms and the medical condition of the patient, ankylosing spondylitis may be managed conservatively or surgically.

  • Symptomatic management with medication – Non-Steroidal Anti Inflammatory Drugs (NSAIDs)/pain killers give relief from inflammation, pain and stiffness.
  • Surgery is usually not required in most AS cases,the however, doctor might suggest this option when the patient is in a progressed stage where the pain is severe. Repair or replacement of damaged joints (hip/knee) and tendons may be done.

What are the lifestyle modifications needed in ankylosing spondylitis?

  • Therapy: Physical therapy has proven to be the most effective in AS. Exercises are designed to improve the flexibility and range of motion. Stretching exercises and strength-building exercises are recommended for improving posture and strength. Proper sleep and walking positions, abdominal and back strengthening exercises are designed to improve or avoid the hunched forward posture and maintain upright position in the patient. Deep breathing exercises are recommended as well.
  • Swimming is recommended as a choice of exercise as it has shown a good result in patients with AS. It helps in reducing pain and improving the posture and breathing.
  • Regular massage with warm oils followed by fomentation provides relief from inflammation and pain.
  • The patient is advised to be active throughout the day. Follow a healthy and balanced diet.
  • Good posture practices.
  • It is best to avoid smoking as tobacco aggravates the condition.
  • The course of the disease can change overtime with the support of patient’s family and friends, along with the support of the doctor.

To know more about ankylosing spondylitis, you can request a callback and our ankylosing spondylitis specialists will call you and answer all your queries.

Specialist Doctors

Dr. Deepthi Nandan Reddy A

MBBS, MS (Ortho), MSc (Ortho, UK), FRCS Ed, FRCS (Ortho, UK), CCT (UK), Advanced Shoulder, Elbow & Hand Fellowships (UK, Mayo Clinic, Rochester & Florida Orthopaedic Institute-USA)

Sr. Consultant Orthopaedic Surgeon, Shoulder, Elbow, Hand and Sports Injuries, Clinical Director

English, Hindi, and Telugu
31 Yrs
Hitec City

Dr. Venuthurla Ram Mohan Reddy

MBBS, MS, MSc, FRCS (Ed), FRCS (Orth), CCT

Senior Consultant Orthopaedic Surgeon

English, Hindi, Telugu
31 Yrs
Hitec City

Dr. Harish C. R.

MBBS,MS (Ortho NIMS)

Sr. Consultant Orthopaedic Surgeon, Joint Replacement & Trauma Surgeon

English, Hindi, Telugu, Kannada
24 Yrs
Hitec City

Dr. Nitish Bhan

MBBS, DNB (Orthopaedic Surgery), MNAMS (Orthopaedic Surgery), MCh (Ortho), Fellow MIS Joint Replacement, Arthroscopy & Advanced Reconstruction

Sr. Consultant Orthopaedic Surgeon

English, Hindi, Telugu
20 Yrs
Hitec City

Dr. Amith Reddy P

MBBS, PGD (Orthopaedics), DNB (Orthopaedic Surgery), MNAMS (Orthopaedic Surgery), MCh (Orth), Fellowships in Arthroplasty, Joint Replacement Surgery, Robotic, Navigation & Conventional

Senior Consultant Orthopaedic Surgeon

English, Hindi, Telugu
18 Yrs
Hitec City

Dr. Kirthi Paladugu

MBBS, MS (Ortho), FIJR

Sr. Consultant Arthroscopy Surgeon Knee & Shoulder (Sports Medicine), Navigation & Robotic Joint Replacement Surgeon (FIJR Germany), Minimally Invasive Trauma, Foot & Ankle Surgeon

English, Hindi, Telugu
16 Yrs
Hitec City

Dr. D. B. Aditya Somayaji

MS (Ortho), Fellow in Foot and Ankle Surgery (USA), Fellow in Joint Replacement

Consultant Orthopaedic Surgeon, Foot & Ankle Surgery

English, Telugu, Hindi
15 Yrs
Hitec City

Dr. Sai Thirumal Rao Veerla

MS Orthopaedics, Diploma in Sports Medicine (International Olympic Committee), Fellowship in Arthroscopy & Sports Medicine (Cardiff, UK)

Consultant Orthopaedic and Trauma Surgeon

English, Hindi, Telugu
12 Yrs
Hitec City

Dr. Krishna Chaitanya Mantena

MBBS, MS Ortho

Associate Consultant Trauma, Joint Replacement & Arthroscopy Surgeon

English, Hindi, Telugu
11 Yrs
Hitec City

Dr. Krishna Subramanyam

MS (Ortho), PDCR, Ph.D

Sr. Consultant Orthopedic Surgeon

English, Hindi, Telugu
29 Yrs
Malakpet

Dr. Praful Kilaru

MBBS, MS (Ortho) AO Fellow (Davos), Chm (Trauma)

Senior Consultant Joint Replacement and Complex Trauma Surgeon

Telugu, Kannada, English, Hindi
18 Yrs
Malakpet

Dr. Pushpak Reddy Chada

MBBS, MS (Ortho) , Fellowship in Joint Replacement (Germany), Fellowship in Sports Medicine and Arthroscopy (Barcelona) Fellowship in Pain Management

Consultant Orthopaedic Surgeon

Telugu, Hindi , English & Tamil
10 Yrs
Malakpet

Dr. Praveen Kumar Rao

MS (Ortho) Fellow Trauma Surgery, Joint Replacement Surgery

Sr. Consultant Orthopedic, Clinical Director & Joint Replacement Surgeon

English, Hindi, Telugu, Tamil, Kannada
27 Yrs
Secunderabad

Dr. Brijesh Kidiyoor

MS (Ortho)

Sr. Consultant Orthopaedic Trauma and Joint Replacement Surgeon & Clinical Director

English, Hindi, Telugu
21 Yrs
Secunderabad

Dr. Jayakrishna Reddy T

MS (Ortho), Fellow in Arthroplasty (Germany), Arthroscopic surgery of Knee & Shoulder

Sr. Consultant Trauma & Orthopedic Surgeon & Clinical Director

English, Hindi, Telugu, Tamil
21 Yrs
Secunderabad

Dr. M. Harry Fernandez

MS (Orthopaedic Surgery)

Honorary/Part Time Consultant Orthopedic Joint Replacement Surgeon

English, Hindi, Telugu, Tamil
21 Yrs
Secunderabad

Dr. R. A. Purnachandra Tejaswi

MBBS, MS (Ortho), DNB (Ortho), FAAC

Sr. Consultant Orthopaedic Surgeon & Clinical Director, Sports Orthopaedics, Arthroscopy, Shoulder Service.

English, Hindi, Telugu
19 Yrs
Secunderabad

Dr. Pawan Kumar Sadhvani

MS (Orthopedics)

Honorary/Part Time Consultant Orthopedic, Joint Replacement, Arthroscopic, Foot & Ankle Surgeon

English, Hindi, Telugu and Gujarati
16 Yrs
Secunderabad

Dr. Sukesh Rao Sankineani

MS (Ortho) - AIIMS (Delhi), Fellowship in Shoulder Surgery & Hip Arthroscopy (France), Fellowship in Arthroscopy & Cartilage Surgery (Italy), Fellowship in Hip & Knee Hip Arthroscopy (AOA, Australia)

Senior Consultant & Clinical Director specializing in Shoulder Surgery, Arthroscopy, and Joint Replacement.

English, Hindi, Telugu
15 Yrs
Secunderabad

Dr. Manish Kumar Jain

MS, DNB, D.Ortho, FNB (Hand & Microsurgery)

Consultant Wrist, Hand & Reconstructive Microsurgeon

English, Hindi, Telugu
11 Yrs
Secunderabad

Dr. Nithin Kumar B

M.Ch (Ortho), MRCS, FRCS Tr & Ortho (UK), Spl, In joint replacement Arthroscopic surgery, Fellowship in Shoulder, Hip & Knee (UK), Dip Sports Medicine (International Olympic Committee)

Sr. Consultant Orthopedics Surgeon & Clinical Director

English, Hindi, Telugu
11 Yrs
Secunderabad

Dr. Vikram Byre

MBBS, D.Ortho, DNB Ortho, FAGE, FIJR, MNAMS

Consultant Orthopedic Surgeon & Robotic Joint Replacement Specialist, Fellow in Hip & Knee Navigation Arthroplasty (Italy), Fellow in Hip & Knee Revision Arthroplasty, Fellow in Musculoskeletal Pain Management

Telugu,English,Hindi,Kannada
10 Yrs
Secunderabad

Dr. Abhinandan Reddy P

MBBS, DNB Orthopaedics, FIJR, FIASM

Associate Consultant-Orthopaedics

English, Hindi, Telugu
9 Yrs
Secunderabad

Dr. Ranjith Nellore Mahesh

MS Ortho, FPIO (Pediatric Orthopedics) FIJR(Joint Replacement Surgery) FIRKR(Robotic Knee Replacement Surgery)

Honorary/Consultant Pediatric Orthopedic Surgeon

Telugu, Kannada, Tamil , English
9 Yrs
Secunderabad

Dr. Swami Nadhan. N

MBBS, DNB (Orthopaedic Surgery), Fellow Joint Replacement

Associate Consultant Orthopaedic Surgeon

English, Hindi, Telugu
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Secunderabad

Dr. Jakku Kranthi

MBBS, MS (Ortho)

Associate Consultant Orthopaedic Surgeon

Telugu, Hindi, English
4 Yrs
Secunderabad

Dr. TMLV Newton

MBBS, MS (Orthopaedics)

Consultant Orthopedic Surgeon

English, Hindi, Telugu
Secunderabad

Dr. P N Prasad

MS (Ortho), BTLS

Consultant Orthopedic Joint Replacement & Arthroscopic Surgeon

English, Hindi, Telugu, Urdu
44 Yrs
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Dr. SV Chandra sekhar Reddy

MBBS, MS (Ortho)

Sr. Consultant Orthopaedic Surgeon

40 Yrs
Somajiguda

Dr. S V S Chandrashekar Reddy

MBBS, MS (Ortho)

Honorary/Part Time Consultant Orthopedic Joint Replacement, Arthroscopic Surgeon, Spine Surgeon

English, Hindi, Telugu
39 Yrs
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Dr. Dasaradha Rama Reddy Tetali

MS (Ortho), FICS, MCh, AO Fellow

Senior Consultant Orthopaedic Surgeon

English, Hindi, Telugu
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Dr. Sunil Dachepalli

MBBS, MS (Ortho), MRCS, CCBST, MSc (Tr & Ortho), MCH (Ortho), FRCS (Tr & Ortho)

Senior Consultant Orthopaedic, Robotic Joint Replacement, Shoulder, Sports Medicine & Trauma Surgeon

English, Hindi, Telugu and Kannada
28 Yrs
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Dr. Manoj Chakravorthy

MS (Ortho), MCh (Ortho)

Sr. Consultant Orthopaedic Joint Replacement & Arthoscopic Surgeon

English, Hindi, Telugu, Kannada
24 Yrs
Somajiguda

Dr. G Kiran Kumar Reddy

MBBS, MS (Ortho), MCh (Trauma and Joint Replacement)

Consultant Orthopedic Surgeon

English, Telugu, Hindi
17 Yrs
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Dr. Badam Kiran K Reddy

MBBS, MS (Ortho), DNB (Ortho), MRCS (Edinburgh, UK), FIJR (DePuy/J&J), FISA (Smith & Nephew), FIPO (Singapore)

Senior Consultant Trauma, Robotic Joint Replacement, Sports Arthroscopy, Ilizarov, Kyphoscoliosis, Endoscopic Spine and Pediatric Orthopedic Surgeon

English, Hindi, Telugu
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Dr. Lokesh Kumar Gupta

MBBS, D.Ortho, DNB Ortho, MNAMS, FIJR

Consultant Orthopedics, Trauma, Arthroscopy and Robotic Joint Replacement Surgeon

English, Hindi, Telugu
12 Yrs
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Dr. Srinivasa Reddy Medagam

Trauma and Sports injuries Specialist <br> Arthroscopy and Joint Replacement surgeon

English, Hindi, Telugu
9 Yrs
Somajiguda

References

  1. Mayo Clinic. Ankylosing spondylitis. Available at: https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Accessed on 15thMarch 2018.
  2. National Institute of Arthritis, musculoskeletal and skin diseases. Ankylosing spondylitis. Available at: https://www.niams.nih.gov/health-topics/ankylosing-spondylitis. Accessed on 15th March 2018.
  3. US National Library of Medicine National Institute of Health. Ankylosing spondylitis. Available at: https://medlineplus.gov/ency/article/000420.htm. Accessed on 15thMarch 2018.
  4. Spondyloarthritis: A Family of Related Diseases. Available at: https://www.spondylitis.org/Types-of-Spondylitis Accessed on 18th March 2018.

Disclaimer: The content of this publication has been developed by a third party content provider who is clinicians and/or medical writers and/or experts. The information contained herein is for educational purpose only and we request you to please consult a Registered Medical Practitioner or Doctor before deciding the appropriate diagnosis and treatment plan.

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