Ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease involving the spine and pelvis joints. More common in men than women

It is mostly seen at young ages and can be confused with spinal calcification called spondylosis when it starts in advanced ages. Inflammation starts from the bone attachment area (entesis) of the tendons in the joint areas connecting the spine, pelvis and legs to the spine, so the basic pathology is enthesopathy. Inflammation can also occur in joints such as knees, ankles, and hips. Since the basic pathology is in the spine, restriction in spinal movements and increased kyphosis cause the appearance of the hunched posture. However, the severity of the disease varies from person to person. In some, it can be seen only in the form of morning stiffness in the spine and low back pain, in addition to these, in the form of pain in the hip and swelling in the knee, in some of them it can be seen as limitation and posture disorder in the entire spine. In fact, inflammatory rheumatic diseases affecting the spine are more than one. Psoriasis rheumatism, reactive arthritis, spinal involvement of inflammatory bowel diseases (ulcerative colitis and Chron’s disease), Reiter’s Syndrome gives similar spine findings to AS, and it is differentiated from each other and AS with some symptoms.

What causes ankylosing spondylitis?

Although studies on its pathogenesis continue, genetics still plays an important role. It has been shown that AS is more common in those with the HLAB27 genetic trait. Symptoms occur when this genetic structure is stimulated by environmental factors and transformed into an active gene region. Among environmental factors, infections trigger the most.

How is ankylosing spondylitis diagnosed?

There is low back pain in the lumbar region, especially in the area of ​​the dimples just above our hip, which we call the sacroiliac joint region. People complain of morning stiffness that lasts longer than 1 hour in the morning. When you get up in the morning, it is very difficult and painful to bend forward to take the slipper, bend over to the sink and wash your face. Especially in the second part of the night (in the morning), since the inflammatory response in the body reaches the highest level, it is the intensity of pain while lying down in this time interval. The person has difficulty in turning from right to left in bed and even wakes up with pain. In some people, the chest area is affected. Chest movements are reduced. Involuntary abdominal (abdominal) breathing is done because there is pain while breathing. Since the main pathology is in the tendons, the Achilles tendon, which is one of the largest tendon areas of our body, is also affected and heel pain is an important finding. Wound in the mouth, anterior uveitis in the eye, bloody diarrhea, skin rashes, fibrotic changes in the lung bases can be seen. Laboratory tests show high inflammation values, negative serology, and positive HLA b27.

How Is Ankylosing Spondylitis Treated?

Early diagnosis and early treatment are important in terms of minimizing the damage that may develop. In addition to drug therapy, the patient also has to actively participate in the treatment of this disease. It is necessary not only to take medications regularly, but also to pay attention to many parameters such as being at a suitable weight, exercising regularly, paying attention to nutrients, sleeping with a single pillow, not smoking, and paying attention to oral care. AS usually progresses in the form of attacks and recovery (silent) periods. In quiet periods, disease activity at the micro level may continue and there may be no obvious symptoms. Therefore, with the awareness that AS is a chronic long-term disease, it is important not to interrupt the follow-up and treatment, and to plan the treatment under the leadership of Internal Medicine-Rheumatology specialists, especially considering its effect on all systems.

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