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Ankylosing spondylitis (spondylitis) / rheumatism Causes, Symptoms and Treatment

The ankylosing spondylitis , also known as ankylosing spondylitis is a rheumatic disease that mainly reached the spine and lower back . It begins in young people, usually men aged 15 to 40 years.

Like all rheumatism , it results in pain and loss of flexibility of the joints. The most characteristic sign of ankylosing spondylitis (AS) is pain in the lower spine at the sacroiliac joints (where the spine attaches to the pelvis).

However, the disease can also affect other joints, such as ankles or knees. It can also be accompanied by inflammation of the eye or digestive symptoms.

It is a chronic and progressive disease , which leads to a progressive stiffness (rigidity) of the joints, hence the term “ankylosing”. Over time, the vertebrae can even weld together, causing stiffness in the spine. However, with early treatment, it is possible to effectively control symptoms and limit ankylosis. Today, severe forms of spondyloarthritis with ankylosis are increasingly rare and specialists tend to no longer use the term “ankylosing”.

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Ankylosing spondylitis is a disease of the family of spondyloarthropathies , which includes several types of chronic inflammatory rheumatism characterized by damage to the vertebral joints. For doctors, it is not always easy to differentiate ankylosing spondylitis from other spondyloarthropathies, especially since the symptoms of these different diseases often overlap.

Prevalence

The ankylosing spondylitis is a relatively rare disease that mainly affects young men , also in good health. The exact prevalence is unknown but most studies estimate it affects 1 in 500 to 1 in 100. The disease is very common in some Amerindian populations.
According to the Canadian Arthritis Society, an estimated 150,000 to 300,000 Canadians have ankylosing spondylitis.
The disease is about 3 times more common in men than in women.

Causes of  Ankylosing spondylitis

The exact cause of ankylosing spondylitis is not known. It is an inflammatory disease , that is, it induces a chronic inflammation of the joints. The disease is probably linked to a set of genetic and environmental factors:

  • Genetic factors  : Ankylosing spondylitis occurs mainly in people who have a particular gene called HLA-B27. This is why it is more common in certain populations or in certain families. However, this gene is not the cause of the disease: it is only a predisposing factor. The HLA-B27 gene is present in 6% of the population and in 93% of people with ankylosing spondylitis. Thus, only 5% to 6% of people with this gene develop ankylosing spondylitis. In addition, other genes are most certainly involved in the disease;
  • External factors  : Researchers believe that environmental factors play a role in triggering the disease in genetically predisposed individuals. It could include bacteria, responsible for gastrointestinal infections (Klebsiella bacteria) or genitals, which would result in immune system changes and trigger the disease. Joint symptoms of ankylosing often appear in the weeks following a genital or gastrointestinal infection .

Complications

Although symptoms may occur periodically, the disease tends to progress continuously as inflammation persists and continues to damage the joints and cartilage (discs) of the back. Over time, vertebral fusion may develop in some patients. However, the evolution of the disease is very slow, over several years.

Attention to cardiovascular risks. When the disease is not effectively treated, chronic inflammation is likely to increase cardiovascular complications. For example, people with ankylosing spondylitis have a higher risk of heart attack or peripheral vascular disease.

Symptoms of ankylosing spondylitis (spondylitis) / rheumatism

Symptoms usually begin at the end of growth (15-16 years) at age 40. There are, however, more rare forms occurring in childhood.

Initial symptoms

  • The disease usually starts with pains of the spine, pelvis, buttocks … These pains are more intense towards the end of the night and can even wake up the affected people;
  • There is stiffness and a limitation of the flexibility of the back, more accentuated in the morning. These last more or less long and fade after a period of “unlocking”, that is to say, heating of the joints;
  • The disease can also start with heel, knee or ankle pain, or swelling of a finger or toe ( dactylitis );
  • Sometimes the disease begins with symptoms that do not affect the joints, for example by inflammation of the eye ( uveitis ).

Evolution of symptoms

The Ankylosing spondylitis is a disease that develops in spurts, interspersed with periods where the symptoms are less pronounced, and sometimes disappear. However, even in the case of total remission, relapses are extremely frequent.

The disease can sometimes only result in pain and stiffness in the back . Other symptoms may be present depending on the case:

  • Ability to move the back and chest less, which can sometimes interfere with breathing. Chest pain during coughing or deep breathing;
  • Achievement of the joints of the limbs (especially near the attachment of ligaments and tendons to the bone): swelling and pain of the shoulders, elbows, knees and ankles;
  • Fatigue, loss of appetite and weight, fever in rare cases;
  • Inflammation of an eye (red and painful eye);
  • Posture rigid or vaulted;
  • Inflammation of the intestine (causing pain, diarrhea …).

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People at risk for Ankylosing spondylitis

In addition to sex (men are more affected than women);genetic predisposition plays an important role.
Thus, a person whose brother or sister suffers from ankylosing spondylitis is 50 times more likely to develop the disease as her.

Risk factors

There is no known risk factor for this disease.

Prevention of ankylosing spondylitis (spondylitis) / rheumatism

Can we prevent?
As we do not know its cause, there is no way to prevent ankylosing spondylitis. However, with some changes in lifestyle , it is possible to prevent exacerbation of pain and reduce stiffness .
Basic preventive measures
In times of pain:

It is advisable not to solicit the painful joints. Rest, adoption of certain postures and massages can relieve pain.

Outside crisis periods:

Certain rules of hygiene of life can help to preserve the flexibility of the joints as much as possible. The pains that characterize ankylosing spondylitis tend to fade after “warming” of the joints. The exercise regularly is strongly recommended.

It is also recommended to move and stretch your joints several times a day: stretching the legs and arms, winding the spine, breathing exercises … The posture of the “cat”, which consists of alternating round back and back hollow on all fours, allows for example to soften the back. Ask your doctor or physiotherapist for advice.

Some tips to limit pain :

  • Sleep on a firm mattress with a flat pillow (or even without a pillow);
  • Sleep on your back or stomach, alternately, and avoid sleeping on your side;
  • Practice a gentle sport activity, such as swimming;
  • Avoid sitting or standing too long without moving the joints;
  • Do not carry heavy loads and learn to protect your back by bending your knees to lift objects;
  • Maintain a healthy weight because excess weight increases joint pain;
  • Stop smoking. Smoking increases cardiovascular risk, already increased in people with ankylosing spondylitis;
  • Relax or practice a relaxation activity because stress can exacerbate symptoms.

Medical treatments of Ankylosing spondylitis

There is no cure for the disease. However, many medications can control symptoms , decreasing inflammation and pain.

As ankylosing spondylitis evolves in flares, some people will only need temporary treatment during painful periods.
Other people, on the other hand, will suffer from a more active form of the disease, with a higher risk of ankylosis. In these cases, long-term treatment , called background therapy , may be necessary. Often, unfortunately, the symptoms may reappear when the treatment is stopped.

However, thanks to current treatments, the majority of people with ankylosing spondylitis can lead a normal life.

Pain treatments

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are the basic treatment for spondyloarthritis. They help reduce pain and inflammation. They include acetylsalicylic acid (Aspirine), ibuprofen (Motrin, Advil, etc.) but also more powerful drugs such as naproxen (Naprosyne), diclofenac (Voltarene), piroxicam (Feldene)or sulindac (Clinoril), which should be prescribed by the doctor. NSAID treatment is usually prescribed until joint pain and stiffness fade, sometimes for several weeks.

 

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Taken over a long period, no steroidal anti-inflammatory drugs can cause digestive complications, such as a stomach ulcer. The doctor often prescribes a medicine to protect the stomach, famotidine (Pepcid), omeprazole (Mopral) or misoprostol (Cytotec), to be taken at the same time as the NSAID. Specific COX-2 inhibitors (Celebrex type) are other NSAIDs that cause less gastric problems. Always consult your doctor before taking an NSAID over a long period.

Injections of corticosteroids . In case of severe pain, the doctor may inject corticosteroids (cortisone) directly into the painful joints. These are powerful anti-inflammatories that provide short-term relief.

Background treatments

When NSAIDs are not enough to alleviate symptoms, a background treatment may be prescribed. The arrival of recent treatments called biological treatments (or anti-TNF-alpha) has significantly improved the management of severe cases of spondyloarthritis.

Sulfasalazine . This medication is sometimes used when the joints of the limbs are affected, but it is not very effective against the pains of the spine. Methotrexate can also be used, but these 2 drugs can cause serious side effects, especially in the blood and liver.

The anti-TNF alpha drugs . The anti-TNF (Tumor Necrosis Factor) alpha, also known as biological response modifiers, are recent drugs widely used for the treatment of inflammatory rheumatism. In case of ankylosing spondylitis, etanercept (Enbrel) and infliximab (Remicade) are commonly prescribed. They can quickly reduce morning pain and stiffness and reduce inflammation. These treatments, however, are very expensive and are only prescribed in case of failure of conventional treatments.

Physiotherapy

Physical exercise is an important aspect of treatment because it helps maintain good posture and increase breathing capacity. However, avoid all exercises that require special effort of the spine, as well as contact sports. The swimming and some stretching exercises that strengthen the back and abdomen are particularly beneficial.
It is advisable to consult a physiotherapist to set up with him a program of exercises adapted to your pain and joint stiffness. Muscle strengthening exercises, especially those that strengthen the back, are also beneficial for maintaining good posture.

Surgery

In severe ankylosing spondylitis, where joints are severely damaged, surgery may be required. It makes it possible to replace the damaged joint, most often the articulation of the hip, with prosthesis. This intervention helps to restore mobility and reduce pain.

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