What is Ankylosing Spondylitis?

Written by Na Hong Wei
Orthopedics
Updated on September 23, 2024
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Ankylosing Spondylitis (AS), where "A" stands for fusion and "S" for spine, refers to the condition where the bones and joints of the spine are fused together. Ankylosing Spondylitis is defined as a chronic inflammatory disease primarily affecting the axial skeleton and major limb joints. It is characterized by fibrosis and ossification of the intervertebral discs’ annulus fibrosus and nearby connective tissues, as well as ankylosis (stiffening) of the joints. It presents as a sterile inflammation occurring in the spine. However, it is not solely limited to the spine as it also involves the axial bones and major limb joints. The pathological hallmark of the disease includes inflammation mainly at the sacroiliac joints and points of attachment to the spine, leading to joint stiffness and calcification of the spinal ligaments and joints. The disease progression begins at the sacroiliac joint, spreading upwards through the entirety of the spine, and eventually stops at the cervical vertebrae. Symptoms start with pain in the early stages, followed by restricted mobility in the intermediate phase, and ultimately leading to deformities of the abdomen and back, culminating in severe hunchback. The exact cause of Ankylosing Spondylitis remains unclear, with various theories proposed but none universally accepted. Additionally, it is categorized under rheumatologic and immunologic disorders.

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Written by Li Jing
Rheumatology
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Is ankylosing spondylitis hereditary?

Ankylosing spondylitis is a systemic autoimmune disease of unclear etiology characterized by chronic inflammation primarily affecting the axial joints, mainly involving the sacroiliac joint. The cause is unclear, and research by experts has shown that the disease tends to run in families, indicating familial clustering. It is not classified as a genetic disease, but there is both familial clustering and a genetic predisposition, meaning that if parents have the disease, their children are much more likely to develop it compared to others. Therefore, if symptoms such as lower back pain or neck stiffness occur, it is advisable to undergo thorough examinations and seek early diagnosis and treatment to delay joint deformity and control the progression of the disease.

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Written by Li Jing
Rheumatology
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Ankylosing Spondylitis Diagnosis Methods

Ankylosing spondylitis is primarily characterized by involvement of the elbow joints, but it can also be accompanied by extra-articular manifestations such as iritis and pain in the heel, and severe cases may present with spinal stiffness and deformity. The cause of the disease is unclear, but studies suggest it is related to genetic and environmental factors, with a significant familial aggregation. Diagnosis requires a combination of clinical symptoms, blood tests including HLA-B27, and imaging such as CT or MRI of the sacroiliac joints to confirm inflammation or damage to these joints. To diagnose ankylosing spondylitis, these three criteria must be met. The most important factor is the presence of clinical symptoms that persist for more than three months, improve with activity, and do not significantly improve with rest. This is a typical characteristic of ankylosing spondylitis.

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Written by Yang Ya Meng
Rheumatology
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How to relieve ankylosing spondylitis

Methods to alleviate ankylosing spondylitis are as follows: First, in terms of lifestyle: during the remission phase of ankylosing spondylitis, it is necessary to persist in long-term functional exercises to keep the spine from adhering and becoming rigid. The second and most important aspect is the long-term use of medication. The medications used to treat ankylosing spondylitis mainly include the following categories: The first category is non-steroidal anti-inflammatory drugs, commonly used ones include diclofenac sodium sustained-release tablets, celecoxib capsules, etc.; the second category includes disease-controlling medications such as sulfasalazine, thalidomide, methotrexate, and even leflunomide. Currently, the most effective medications for treating ankylosing spondylitis are biologics. However, before using biologics, it is essential to strictly rule out diseases such as hepatitis, tuberculosis, and tumors. (Medications should be used under the guidance of a doctor based on specific conditions.)

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Written by Li Jing
Rheumatology
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Can people with ankylosing spondylitis have children?

Firstly, ankylosing spondylitis is an autoimmune disease and is chronic. This disease cannot be cured; rather, it is managed long-term through medications to alleviate symptoms, control the progression of the condition, and delay the onset of joint deformities, which is the main purpose of treatment. This disease is not hereditary, but there is a clear phenomenon of familial aggregation. For instance, if one or both parents have it, the incidence in their children is over 50%. Patients with ankylosing spondylitis can have children, but there is a very high probability that their children will also suffer from the disease. Additionally, it is advised not to conceive while on medication during the treatment period; one must stop taking the medication for more than three months before considering pregnancy.

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Written by Li Jing
Rheumatology
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How is ankylosing spondylitis diagnosed?

Ankylosing spondylitis is an autoimmune disease that cannot be cured but can be managed primarily through medication. Its main typical symptoms include stiffness in the neck or pain in the lower back, with the pain becoming more apparent when at rest or after sitting for a long time. Symptoms tend to improve with movement. A typical occurrence is pain that awakens the patient at night. Peripheral joints like the knee joint and heel can also be affected. However, the main symptoms are stiffness in the neck and pain in the lower back. Diagnosing ankylosing spondylitis requires combining symptoms with a positive B27 blood test result, and imaging tests such as CT or MRI of the sacroiliac joints, showing signs of sacroiliitis, narrowing or damage in the sacroiliac joint space, to confirm the diagnosis.