Understanding Ankylosing Spondylitis -- Diagnosis and Treatment

How Do I Know If I Have Ankylosing Spondylitis?

There is no specific test to diagnose ankylosing spondylitis, but imaging by X-ray and MRI may show evidence of inflammation of the sacroiliac joint between the sacrum (the triangular bone at the lowest part of the back) and the ilium (the bone felt on the upper part of the hip). Some symptoms may include:

  • Inflammatory back pain (gradual in onset, lasting over three months, with stiffness and pain that is worse in the morning and improved with movement)
  • Reduced mobility of the spine
  • Reduced ability to expand the chest

Your doctor may order a number of different blood tests that can suggest ankylosing spondylitis. For example, if you have the disorder, you are likely to have an increased erythrocyte sedimentation rate (the rate at which red blood cells settle out of your blood) and increased levels of C-reactive protein (a protein that is usually not in blood at high levels but may be elevated in cases of inflammation). These two tests are general indications of inflammation in your body.

You may also have anemia. To exclude other causes of inflammatory arthritis, tests for rheumatoid factor (an antibody common in cases of rheumatoid arthritis) and anti-nuclear antibodies (common in cases of lupus and other similar conditions) may be ordered, which are usually negative in ankylosing spondylitis. Between 85-90% of Caucasian people with ankylosing spondylitis are positive for the HLA-B27 marker.

What Are the Treatments for Ankylosing Spondylitis?

If you are diagnosed with ankylosing spondylitis, it is important to seek help from a physical therapist. Regular exercise and efforts to maintain mobility may make the difference between preserving your movement and independence and becoming debilitated.

Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with spondylitis, because it helps maintain proper extension of the spine. For smokers, it is advisable to quit due to the potential breathing problems associated with ankylosing spondylitis.

Good posture is important. Patients should choose chairs, tables, and other work surfaces that will help them avoid slumped or stooped postures. Patients are encouraged to sleep on a hard mattress with their back straight. Do not sleep on several pillows with your neck flexed forward. Lying face down with the arms extended is an exercise to help maintain an erect posture.

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During flare-ups of the disease, and to control symptoms, you may need to take anti-inflammatory drugs. The drugs sulfasalazine and methotrexate may help some people with ankylosing spondylitis for symptoms in joints other than the spine. Biologic drugs also used for rheumatoid arthritis, including adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponi Aria), infliximab (Remicade), and infliximab-dyyb (Inflectra), a biosimilar to Remicade, as well as secukinimab (Cosentyx), can significantly relieve inflammation and pain in many people with spondylitis if anti-inflammatory drugs aren't controlling symptoms.

If you develop very severe arthritis of the hips, you may eventually need surgery to replace your hips. If you develop inflammation of the eye, you may be given steroid eye drops.

How Can I Prevent Ankylosing Spondylitis?

There are no known ways to prevent ankylosing spondylitis. The condition is largely due to genetics, although you may not be aware of anyone in your family with similar symptoms.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on December 06, 2016

Sources

SOURCES: 

American College of Rheumatology. 

The Mayo Clinic. 

Spondylitis Association of America. 

Sportsinjuryclinic.net.

Reveille, J.Am J Med Sci., 2011 Apr; 341(4): 284-286.

Brown, M. Arthritis & Rheumatism, Dec. 2005.

FDA. “FDA approves Inflectra, a biosimilar to Remicade.” FDA approves Amjevita, a biosimilar to Humira.”

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