Axial Spondyloarthritis, also known as Ankylosing Spondylitis (AS), is a type of inflammatory disorder that typically affects the joints of the spine. However, it can also affect the joints in the other areas of the body such as the hips, knees, ankles and feet. Patients may experience problems with walking, getting out of bed, bending forward and other daily activities.
As the condition progresses, the disease may cause fusion of the spine and patients may experience difficulty in turning their head or bending forward to put on their shoes.
Generally, Axial Spondyloarthritis affects 1 per 500-1000 people, who are mainly in their third decade of life. It is equally common in both males and females. Family members of affected people are at higher risk, depending partly on whether they inherited the HLA-B27 gene.
The first signs of Axial Spondyloarthritis are pain and stiffness in the lower back, especially after prolonged periods of inactivity. This can be especially bad in the morning and patients might have difficulty getting out of bed. This is quite different from back strain which is better with rest.This may be associated with pain in the hips, knees and feet, especially at the heel. As the condition progresses, the pain and stiffness can affect the entire spine and last the whole day. This causes difficulty in walking, sleeping, getting out of bed, bending forward and other activities of daily living. Patients with active Axial Spondyloarthritis often experience fatigue, poor appetite and weight loss. The eyes can also be affected in Axial Spondyloarthritis and the symptoms include redness of the eyes, increased sensitivity to light and blurred vision. Patients might also experience swelling of the joints of the fingers and toes, and even chest pain when taking a deep breath. Some patients can also develop inflammation of the intestines and pass bloody or slimy stools. Patients can also develop red and silvery skin rashes, also known as psoriasis.
The cause of Axial Spondyloarthritis is unknown, but the genes that you inherit from your parents might make you more susceptible. Most of the patients with Axial Spondyloarthritis have a gene called HLA-B27. Almost 90% of people with Axial Spondyloarthritis are carriers of HLA-B27.
Other risk factors include history of skin psoriasis, inflammation of the eye (uveitis), inflammatory bowel diseases, and reactive arthritis in the patient or his family members.
Having the HLA-B27 does not mean that you will develop Axial Spondyloarthritis. Only 1-5% of HLA-B27-positive individuals in the general population develop Axial Spondyloarthritis.
Your doctor will review your family medical history and conduct a physical examination especially of your spine and your limbs. If your doctor suspects that you may have this condition, you may be required to perform blood investigations and X-rays of your spine.
X-ray changes of the sacroiliac joints, known as sacroiliitis, is a key sign of spondyloarthritis. If X-rays are normal, but the symptoms are highly suspicious, your doctor may perform magnetic resonance imaging (MRI) on you, which are able to show these joints better and can pick up early involvement.
Specialised and dedicated clinics that treat patients with Axial Spondyloarthritis may result in better outcomes. Treatment of Axial Spondyloarthritis is focused on alleviating symptoms of pain, stiffness and fatigue, and preventing worsening of the condition and complications such as inflammation of the eye. There is also a need to regain and maintain the mobility of the spine and reduce inflammation in the joints, digits and tendons of the upper and lower limbs.
1. MedicationNSAIDs (non-steroidal anti-inflammatory drugs) are important in reducing inflammation, pain and stiffness of the digits, joints and tendons in your upper and lower limbs. Other pain-relieving drugs may also be used.
Depending on the joints involved and the severity of the condition, steroids and DMARDs (disease-modifying anti-rheumatic drugs) may be prescribed to reduce the inflammation of your joints. In patients who respond poorly to NSAIDs and DMARDs, you may be considered for biological therapy.
Biologics are complex mixtures of proteins that target specific parts of the immune pathway to reduce inflammation. Currently available biological therapies for Axial Spondyloarthritis locally include anti-tumour necrosis factor (TNF) drugs, such as etanercept, adalimumab, golimumab and infliximab, as well as interleukin 17 inhibitors, such as secukinumab and ixekizumab. They are very effective in treating both the spinal and peripheral joint symptoms of Axial Spondyloarthritis. These drugs are injected subcutaneously (under the skin) or may require infusion in the hospital at regular intervals.
However, biological treatment is expensive and not without side effects, including an increased risk for serious infections, e.g. development of active tuberculosis. Your doctor will discuss the cost and weigh the benefits and risks with you when considering treatment with biological therapies. Treatment with biological therapies are safe if monitored properly.
2. ExerciseExercise, including stretching, helps reduce stiffness of the spine and limbs. Generally, swimming is recommended for all forms of arthritis. Other individualised physical therapies will also be recommended by the rheumatologist and physiotherapist. In order to be effective, all exercises need to be done regularly and on a long-term basis.
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