Ankylosing or ankylosing spondylitis is an inflammatory disease of the musculoskeletal system that affects the joints of the spine and can eventually fuse or weld the vertebrae together, resulting in severe stiffness and limited mobility.
The disease is more common in males, and usually appears between 20 and 30 years of age; it affects 0.5% of the adult population. It is more common in whites than in blacks.
This condition may affect only the cervical, dorsal or lumbar spine, including the sacroiliac joints. On other occasions, spondylitis affects the spine and the peripheral joints of the extremities. Sometimes inflammation of the tendons at the attachment points with the bone, on the Achilles tendon, the plantar fascia and the patellar tendon can be added to all of the above.
This disease presents familiar aggregation and an important genetic base. It can be associated with other diseases such as psoriasis or certain inflammatory intestinal or ocular diseases (ulcerative colitis, Crohn’s disease, uveitis).
Causes of spondylitis
Its cause is not known exactly. There is an undoubted genetic substrate which is evidenced by the frequent association in certain families, the higher frequency of presentation when there are other relatives with the disease and the association with a genetic marker which is the histocompatibility antigen HLA-B27. The latter is detected in more than 90% of patients with spondylitis.
This genetic basis would facilitate the action of environmental agents in the production of the inflammatory disease, probably through changes or modifications of the intestinal microbiota. This would set in motion a chronic inflammatory process that would damage the joints between the vertebrae and ossify them, welding and fusing them.
Is there any possibility of preventing spondylitis?
No, there is no way to prevent the disease. The genetic component is unmodifiable; if a person inherits HLA-B27 from his/her parents, he/she has a 20-25% chance of suffering from the disease. In the white race this antigen appears in 6-10% of the general population: be careful because having HLA-B27 does not mean that you have the disease.
Symptomatology of spondylitis
It usually manifests with lumbar pain; this pain, unlike the usual lumbago, usually appears at night, in the early morning, wakes the patient up and forces him to get out of bed and walk around the room to feel relief. It is accompanied by intense morning spinal stiffness. In general, patients are better when exercising and moving than when resting.
Arthritis may also be associated, i.e. inflammation of a joint in the extremities, especially in the lower limbs: knee, ankle, feet. As the disease also inflames the areas where the tendons are attached to the bones, tendinitis processes are very frequent. Along with these symptoms of the locomotor system, sometimes ocular, genitoruinary, intestinal or mucosal and skin symptoms are associated: conjunctivitis, uveitis, chronic diarrhea, prostatitis or psoriasis of the skin.
Spondylitis: treatment
Early diagnosis is essential to maintain the window of opportunity provided by the inflammatory process before ankylosing the joints. The basis for diagnosis is clinical suspicion and demonstration by an analytical-radiological test of the existence of joint and spinal inflammation. A simple skeletal X-ray and a simple blood test may be sufficient; in more complicated cases, MRI or CT or CT scan should be used.
Appropriate treatment is usually effective. It includes rehabilitative physical therapy, non-steroidal anti-inflammatory drugs and so-called biological therapies. The latter are indicated when previous attempts fail. These include anti-TNF agents (etanercept, infliximab, adalimumab, certolizumab, golimumab) and secukinumab. In general, the prognosis, when the disease is properly diagnosed and treated, is good; pain and inflammation can be eliminated and spinal deformity can be corrected.
In any case, it is advisable to visit a doctor specialized in Rheumatology and an adequate, close and active follow-up for the timely control of the disease.