Early diagnosis helps preventing development of severe joint and spine deformities.
“Ankylosis” is a term that represents severe loss of movements in a joint due to formation of bone or fibrous tissue in the joint. Ankylosing Spondylitis is a type of a chronic inflammatory arthritis that predominantly affects the spine, apart from other big joints of the body. It usually affects males in twenties to forties, especially in those who have a genetic predisposition. It leads to gradually worsening stiffness and deformities in the spine and other joints, eventually making the person severely crippled or completely bedridden.
The main reason this disease is often diagnosed late is that the symptoms are mild and sometimes vague, waxing and waning in nature. Back pain, neck pain or multiple joint pains associated with morning stiffness lasting at least 30 minutes is the hallmark. Usually it stars affecting the sacroiliac joints (See Fig) in the lower back that causes low back pain. As low back pain is an otherwise common problem, it may be treated mostly as a nonspecific back pain for a considerable time before being diagnosed. Sometimes it is associated with inflammatory disorder of bowels or eyes. Restricted chest expansion may affect the lung function.
But many patients would have already developed ankylosis of multiple joints by the time it is diagnosed and may have fixed deformities in the back, neck, hip or knee joints. Once a joint is ankylosed, it is not possible to get back the natural movements in that joint. As spine becomes deformed and fixed in a forward bent position (kyphosis), the person may not be able to look straight forwards more than a few feet ahead on standing. Loss of neck movements is often associated and further limits the ability to maintain an adequate forward gaze. Loss of movements in the hip or knee joints leads to disability in sitting, changing posture and in walking.
If this condition is recognised well in time, the development of permanent deformities and disability can be prevented by appropriate medication and regular exercises to prevent loss of joint movements. The diagnosis is mainly based on clinical features, X-rays and some blood tests. An MRI may be required often. An orthopaedician and rheumatologist must be consulted and a good physiotherapist is a must for successful treatment. It is important to continue exercises for long term to prevent joint stiffness. Activities like yoga, swimming and sports are useful additions and must be encouraged. Medication is another important aspect of treatment and is best decided by a rheumatologist based on level of disease activity.
If detected early and managed well with long term exercises and appropriate medication, patients with ankylosing spondylitis can have an almost normal life.
Patients with severe spinal deformity may need a surgical correction to improve the posture. Joint replacement of hip or knee joints are done to restore mobility and reduce disability.
