Q: What is ankylosing spondylitis?
A: Ankylosing Spondylitis (AS) is the most common form of spondyloarthritis, the name given to a family of inflammatory rheumatic diseases that cause pain and stiffness in and around sites where ligaments and tendons attach to bones.
Ankylosing spondylitis mainly affects the spine. It causes the joints of the neck, back and pelvis to become inflamed, causing pain and stiffness. AS can also affect other joints such as the shoulders, hips, knees, ankles and the joints between your ribs and breastbone.
Q: How common is AS and who is most likely to get it?
A: Ankylosing spondylitis affects about 1–2% of Australians and around 1% of New Zealanders. You are more likely to get AS if you have a history of it in your family.
The disease usually first appears between the ages of 15–40 years and is about three times more common in men than in women.
Q: What causes AS?
A: It is not known what causes AS. Unlike other types of back pain, AS isn’t caused by particular jobs, activities or injuries. There is a gene called HLA-B27 that is associated with AS. Almost nine out of ten people with AS test positive for this gene. However HLA-B27 is present in 8% of the general population, including healthy people without AS. Recently, two new genes (IL23R and ARTS1) have also been found to be associated with ankylosing spondylitis.
Q: What are the symptoms of AS?
A: The symptoms of AS vary from person to person. The most common are:
- pain and stiffness in the back, buttocks or neck
- symptoms worse after rest (for example, in the early morning) and relieved with exercise
- pain in tendons (which connect muscles to bones) and ligaments (which connect bones to each other), often felt as pain at the front of the chest, back of the heel or underneath the foot.
When AS is severe, it can cause some of the vertebrae in the spine to join together, or fuse. When these bones fuse, it can make the spine inflexible and create a hunched over posture and severely limit mobility.
Ankylosing spondylitis can get worse over time, which is why getting help from a doctor as soon as possible is important.
Q: How is AS treated?
A: There is no cure for ankylosing spondylitis, but there are several approved treatments that can help manage the symptoms. Options include over-the-counter pain relievers, anti-inflammatory drugs, and prescription medicines. Your doctor may also prescribe an individualised exercise program. These treatments can help manage symptoms of AS, including pain.
Q: How is AS diagnosed?
A: The average time from when a person first noticed symptoms of AS to diagnosis of AS is about 8 years. That’s at least partly because AS can be difficult to diagnose in its early stages. Not only does AS affect people in different ways, it also usually begins very slowly. It can also be mistaken for other forms of arthritis, especially if pain begins in the hips, knees or shoulders. To add to these difficulties, there is currently no single test to identify the disease. Instead, diagnosis is usually based on the expert clinical evaluation of a rheumatologist.
The difficulty in diagnosing AS makes it important that you are prepared to tell your doctor about all of your symptoms. For a clinical diagnosis, your doctor will likely refer you to a rheumatologist and/or:
- Ask about your medical history
- Consider all your symptoms
- Perform a physical examination
- Run some laboratory tests on a sample of your blood
- Send you for x-rays or other diagnostic imaging tests to look for changes in your joints
Q: If I’m diagnosed with AS, is there anything I can do to manage my symptoms?
- Eat a healthy diet. No diet has been proven by research to cure arthritis. Be very cautious of special diets or supplements that claim to cure arthritis. The best diet for arthritis is a healthy, balanced one to maintain your general health and prevent other medical problems.
- Eat certain fatty foods. Studies show that eating a diet rich in omega-3 fatty acids may help reduce inflammation. Foods rich in omega-3 fats include:
- fish: oily fish, such as sardines and salmon, have greater amounts of omega-3 fats.
- fish oil supplements
- ground linseeds and linseed oil (also called flaxseed)
- canola oil (also called rapeseed oil)
- Stretch. Stretching may help increase your range of motion and can improve your posture.
- Exercise. Regular physical activity benefits everyone, and is one of the most effective treatments for ankylosing spondylitis. It helps to reduce your pain, strengthen your muscles, maintain good posture and improve your sleep and overall health.
Activities that are likely to be good for your fitness and posture include swimming, walking, jogging, low-impact aerobics and tennis.
Supervised physical therapy is considered to be the most effective. Talk to your doctor before starting any exercise routine or program.
- Ask your health care team about canes, walkers and other devices. There are a number of aids available to make functioning easier and more comfortable. You can find out about them at Independent Living Centres in each state that provide advice on products and services, including aids and devices, that can help with day-to-day activities. Visit www.ilcaustralia.org.au or call 1300 885 886 to find your closest centre or more information.
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