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New Delhi: Ankylosing spondylitis (AS) is a form of inflammatory arthritis that affects the spine and leads to extreme pain, stiffness and ultimately fusion of the spine. It can involve other joints such as shoulders, hips, ribs, heels, etc. AS symptoms usually manifest in young adults in their 20s or 30s. But most people ignore early signs of AS, which over time, results in fusion of the spine in abnormal positions leading to reduced quality of life.

Due to COVID-19, work from home has become a new norm. Sitting for long hours in an abnormal position, slouching, rounding up shoulders and putting your head forward are some of the bad postures that most people adopt while working from home during the pandemic. These unfavourable sitting positions in addition to AS related arthritis leads to the development of complications. Dr Ashish Dagar, Orthopaedic Spine Surgeon, CK Birla Hospital, Gurugram shares with us everything that we need to know about Ankylosing spondylitis.

Key symptoms of Ankylosing Spondylitis

Ankylosing Spondylitis have some key symptoms, but they also vary from person to person. AS usually starts before the age of 40 years and progresses over the years. Patients who develop AS may experience back pain and early morning stiffness which gets better with daily activities. Some might also experience shooting pain in the back, joints, buttocks and in the backside of the thigh.

Symptoms of AS are cyclic in nature, that is, they tend to go away and come back over a period of time, but the disease is almost always progressive in nature. Over course of time, symptoms become severe and asymptomatic period duration shortens.

Major symptoms are – 

●    Lower Back pain

●    Early morning stiffness

●    Spine deformities, mainly Kyphosis – stooping forward deformity

●    Straight and Stiff spine

●    difficulty in breathing in advanced stages of disease when rib cage is fused

●    Generalised weakness, fatigue and anaemia

●    peripheral joint pain – hip joint, shoulders etc.

●    Eye involvement

The exact cause of Ankylosing Spondylitis is still unknown

The exact cause of Ankylosing Spondylitis is still unknown, but the most favoured hypothesis is genetic pathophysiology. A gene, HLA – B27 is the prime suspect as it is positive in 95 percent of cases who have this disease.

Ankylosing Spondylitis affects genders differently

Ankylosing Spondylitis tends to affect males more frequently than females. Males also tend to develop the disease at a younger age as compared to females.

However, they have lower disease progression and a better quality of life.

Diagnosis of Ankylosing Spondylitis

A thorough medical history, physical examination and medical diagnostic tools are must to diagnose Ankylosing Spondylitis

●    Erythrocyte sedimentation rate (ESR) – ESR is raised in 70 percent of AS patients. It is a nonspecific marker of inflammation. It is a very good tool to monitor disease activity and guide medical management.
●    X-ray – X rays of Pelvis, Spine and Sacroiliac joints can reveal joint destruction and fusion. These changes are peculiar for AS.
●    MRI – MRI with contrast is the most sensitive test to diagnose early involvement of Sacroiliac joints in AS.
●    Genetic testing – Done to test for presence of the gene HLA-B27.

How is Ankylosing Spondylitis managed?

The goal of management is to improve quality of life by reducing pain and stiffness, preventing development of deformities and slow down progression of disease.

Treatment includes:

●    Nonsteroidal anti-inflammatory medications, to reduce pain and inflammation

●    Biologics – Tumor-necrosis-factor blockers – to reduce inflammation and swelling

●    Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine.

●    Short-term use of corticosteroids to control disease activity

●    Maintaining of proper posture to prevent development of deformities

●    Regular exercise and maintenance of mobility

●    Surgery to improve quality of life and manage complications – spine deformity correction, spine decompression, joint replacement etc

Ankylosing Spondylitis related deformities can be prevented

With conscious efforts in improving posture, exercising and taking optimal breaks to stretch between constant hours of work, AS related deformities development can be delayed. People must ensure a comfortable chair with adjustable height to sit. The feet should be touching the ground and not hanging. Also, at least a 5 min break should be taken every hour to break the position you are sitting in. Walk around to ensure movement. Movement relaxes the tissues, lubricates joints, prevents stiffness and improves blood circulation. Lastly, don’t slouch, sit an inch taller frequently.


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