What is ankylosing spolitis?

Ankylosing spondylitis is a chronic, inflammatory, and systemic disease of unknown origin that predominantly affects the spine.

Its main alterations occur in the areas of insertion of ligaments and tendons in the bone (enthesis), in the synovial membrane and in the articular cartilage.

This disease affects mostly men (1 woman for every 3 men) and generally begins between 15 - 30 years.

Ankylosing spondylitis generally begins affecting the lumbar spine, that is, the lower part of the back manifesting itself with insidious onset pain, which worsens with rest, waking up the patient at night. It is common for this pain to improve with exercise. Like other autoimmune diseases, patients present with morning stiffness.

Other less typical manifestations of the disease can be pain in the hips, iliac crest and especially in the heels.

If the thoracic spine is affected, it can lead to limited thoracic expansion.

The incidence of the disease parallels the prevalence of the human leukocyte antigen B27, with which it is closely associated.

This is obtained through a blood sample and more than 90% of patients with ankylosing spondylitis are HLAB27 positive, while in the general population this prevalence is 7% (studies on this relationship continue to be carried out)

When disease is suspected, this blood test is performed to confirm it.

Having this antigen in the blood doesn't means that we will develop the disease. However, if it is positive, there is clinical data, affected relatives and radiological signs that suggest the disease is very likely to happen.

Ankylosing spondylitis can affect other organs:

  • Acute anterior uveitis: it is the most frequent extra-articular manifestation (25-30%), it manifests as pain, intolerance to light, lacrimation and blurred vision. It generally occurs in only one eye and the attacks usually do not last more than 2-3 months and fortunately pass without leaving sequelae, but they can recur.

Less frequent:

  • Cardiovascular conditions: inflammation of the aortic root
  • Pleuropulmonary manifestations: can cause fibrosis and pulmonary cysts generating cough, feeling of lack of air
  • Genitourinary manifestations: inflammation of the prostate, impaired kidney function.

Certain clinical and radiological criteria are used for the diagnosis of this disease.

Clinical Criteria:

Limited mobility of the spine

Pain in the lumbar spine (lower back)

Thoracic expansion limitation.

Radiological Criteria:

Sacroiliitis data (which is directly assessed by the doctor after taking an x-ray)

Ankylosing spondylitis can be treated through the use of anti-inflammatory drugs, the most used for this disease is Indomethacin.

In addition, corticosteroids and biological therapy can be used (on which there is much research and studies currently).

Ankylosing spondylitis has a slow course, with exacerbations and fortunately prolonged remissions.

La gran mayoría de los pacientes no evolucionan a una anquilosis, teniendo una vida prácticamente normal.

It has a poor prognosis when the disease begins at an early age (before the age of 16).

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