Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, leading to pain and stiffness. It’s part of a group of autoimmune conditions known as spondyloarthropathies, and it tends to strike in early adulthood, often between the ages of 20 and 40. What sets AS apart is that it causes inflammation where ligaments and tendons attach to bones, especially along the spine, which can lead to the fusion of vertebrae over time—a process called ankylosis. This fusion can significantly reduce flexibility, resulting in a hunched-forward posture in severe cases.

The exact cause of AS isn’t fully understood, but there’s a strong genetic component. The HLA-B27 gene is present in the majority of people with AS, although having the gene doesn’t guarantee the disease will develop. Environmental triggers and immune system dysregulation are also thought to play a role. Symptoms typically begin gradually and may include persistent lower back pain, morning stiffness that improves with activity, fatigue, and in some cases, pain in the hips, shoulders, or heels. Extra-articular manifestations like uveitis (eye inflammation), heart valve problems, or lung involvement can also occur in some individuals.

Management of ankylosing spondylitis focuses on controlling symptoms and preventing progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment to reduce pain and inflammation. For more severe or refractory cases, biologic agents such as TNF inhibitors (like adalimumab or etanercept) or IL-17 inhibitors are used to target specific pathways in the immune response. Physical therapy and regular exercise are essential components of care to maintain posture, spinal mobility, and overall function. While there’s currently no cure, with early diagnosis and a comprehensive management plan, many people with AS can lead active, productive lives..

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