I. What is ankylosing spondylitis (referred to as strong column or AS)?
It is a type of arthritis that primarily affects the back of the spine. Symptoms of AS often occur first in young people between the ages of 16 and 30. The disease is less common in women, has milder symptoms, and is more difficult to diagnose. 5% of patients with strong column develop it in childhood. In patients with a strong column, inflammation occurs in the joints and ligaments that allow normal back movement and extension. This inflammation leads to pain and stiffness, usually starting in the lower back and progressing over time to the upper spine, chest and neck. Eventually the joints and bones (vertebrae) can grow together and fuse with each other, making the spine stiff and unable to flex and extend. Other joints, such as the hip, shoulder, knee or ankle, can also become inflamed.
Strong column is a chronic disease. The severity of symptoms and the degree of loss of work capacity vary from person to person. Early diagnosis, regular treatment and appropriate joint exercises can help control the pain and straightening caused by strong column and reduce or prevent severe deformities.
Second, the cause of ankylosing spondylitis and the relationship with HLA-B27
The cause of strong column is unknown, but genetics and heredity are a definite factor. Scientists have found that a gene called HLA-B27 is associated with the disease in 90% of patients. However, having the HLA-B27 gene does not necessarily mean you will get strong column. A person who carries the HLA-B27 gene and has no relatives with a strong column has only a 2% chance of having a strong column. For a person who has a parent or sibling with the HLA-B27 gene, the chance of having the disease is only 20%. Therefore, there are other factors besides the HLA-B27 gene that contribute to the development of the strong column.
Symptoms of ankylosing spondylitis
The inflammation of the strong column usually starts around the sacroiliac joints. The sacroiliac joint (at the hip) is the joint in the lower part of the spine that connects to the pelvis.
The most common of the early symptoms of strong column is chronic pain and joint stiffness in the hips, lower back and hips. This discomfort can develop over a period of weeks or even months. Unlike the pain in the lower back caused by other diseases, the pain in strong column is worse at rest and during inactivity. Patients often wake up in the middle of the night with back pain, have difficulty turning over, and feel significant stiffness in the morning, usually made less severe by exercise.
Over time, the pain and stiffness progress to the upper spine and even affect the thorax and neck. Eventually, inflammation can cause the sacroiliac and vertebral bones to fuse and grow together. When the bones fuse, the spine and neck lose their normal extension and flexion and become rigid. The thorax can also fuse, limiting normal thoracic expansion and making breathing difficult. Inflammation and pain can also occur in the hip, shoulder, knee, and ankle joints resulting in limited motion. The heel can also be affected making standing or walking on hard surfaces uncomfortable.
The disease can cause fever, loss of appetite, weakness, and inflammation of internal organs such as the lungs, heart, and eyes (e.g., iritis).
Fourth, what is undifferentiated spondyloarthropathy (uSpA), seronegative spondyloarthropathy (SpA)?
Because patients in the early stages of the disease only have symptoms similar to strong column (hip pain, inflammatory low back pain or hip pain, etc.), but no limitation of spinal motion or x-ray changes of the sacroiliac joints, this group of patients is difficult to be diagnosed as strong column in the early stages, and is often diagnosed as spondyloarthropathy. With treatment, 20-30% of these patients can be cured (do not develop); another 50% or so develop a strong column. Therefore, in the early stages of this type of disease, some doctors also call it undifferentiated spondyloarthropathy (uSpA).
The symptoms of a strong column can be similar to those of reactive arthritis or Wright’s syndrome, psoriatic arthritis, and arthritis associated with inflammatory bowel disease. These diseases are generally seronegative for rheumatoid factor, so they are also collectively referred to as seronegative spondyloarthropathies.
V. Diagnosis of ankylosing spondylitis
The diagnosis of ankylosing spondylitis can be made by the physician based on the patient’s symptoms, signs, and sacroiliac joint radiographs. If the x-ray results are suspicious, then a CT scan will be more sensitive to the disease. The doctor will also test the blood for the HLA-B27 gene. 90% of patients with ankylosing spondylitis have a positive result on this test.
Treatment of ankylosing spondylitis
Treatment of ankylosing spondylitis focuses on relieving pain and stiffness, preventing deformities, and helping to maintain normal motor function. The following are several aspects of ankylosing spondylitis treatment.
(a) Medication: Medication is a core part of the treatment of ankylosing spondylitis.
Non-steroidal anti-inflammatory drugs, or anti-inflammatory pain medications, help relieve pain and stiffness, allowing you to exercise to maintain good body posture and continue normal activities.
Disease relief-anti-rheumatic drugs (DMARDs) such as salbutamol and methotrexate can reduce inflammation and slow or stop the progression of the disease. Biologics are currently the most effective drugs for the treatment of strong column, but they are expensive.
(B) Maintain good body posture: Whether you are walking, sitting or lying, it is important to maintain proper posture to prevent joint fusion.
Sleep on a hard bed with a low pillow (just enough to fill the space behind your neck), sleep on your back, straighten your legs, and don’t sleep with your body bowed.
When you stand, walk or sit, you should straighten your back as much as possible, put both shoulders flat and set your head straight.
(C) Exercise: Regular movement and exercise is an important part of the whole treatment of strong column.
Exercises to strengthen your back and neck help maintain and improve your body posture. Deep breathing and aerobic exercises help to maintain the elasticity of your thorax. Exercises such as gymnastics, tai chi, and swimming are a good choice to help maintain flexibility in the spine, neck, shoulders, and hips, and to encourage you to breathe deeply.
If you feel too stiff and sore to exercise, a hot bath will relax your joints and muscles. Start slowly and choose when you have the most energy and the least pain. Exercise as much as you can without worsening your pain the next day.
(d) Surgical treatment: If the hip joint is already strong, joint replacement surgery can allow the patient to regain joint motion function.
If your spine is severely bent forward and you cannot look straight ahead, surgery can help you straighten your back. Because of the complexity of this surgery, only a few specialized medical centers can do it.
VII. Work environment problems
The vast majority of people with ankylosing spondylitis can continue to be active and creative, whether you are doing housework or working. The following suggestions may be useful to you.
1. Avoid lifting heavy objects, working prone, and maintaining a tense or stooped posture for long periods of time.
2. Change your posture frequently, moving at least once an hour. Some patients find it useful to alternate sitting and standing. If you feel pain when sitting, put a chair cushion on it.
3. Schedule some short rest intervals throughout the day, if possible. Remember: maintaining a certain amount of activity each day will maintain your motor function to the greatest extent possible.
If your current job requires you to bend for long periods of time or back tension, then you’ll have to find a way to change jobs.