Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a rheumatic condition where your body has what is called systemic inflammation. This means there is inflammation somewhere in your body caused internally as opposed to wear and tear like Osteoarthritis or typical degeneration. AS typically targets the sacroiliac (SI) joint. The SI joint is the joint made between your spine and your pelvis as your axial weight divides into both of your legs. The inflammation here can lead to bony deformation and eventually a fusion of the SI joints and the lumbar spine.
When diagnosing AS, clinical factors as well as imaging and bloodwork are taken into account. Typical testing includes radiographic (xray), MR, and blood work to look for inflammatory markers as well as one specific to AS, such as HLA-B27. The New York criteria for diagnosis includes having back pain for more than 3 months that improves with exercise but is not relieved with rest, a limited range of motion in the lower back (particularly forward and back as well as side to side motion), and a limited range of motion when expanding the chest (compared to normal values for age/sex).
When managing AS the primary lead of the healthcare team should be a rheumatologist. There are 4 overarching principles for managing AS.
AS is a potentially severe disease with diverse manifestations, usually requiring multidisciplinary treatment coordinated by a rheumatologist.
The primary goal of treating the patient with AS is to maximize long term health-related quality of life through control of symptoms and inflammation, prevention of progressive structural damage, preservation/normalization of function and social participation.
Treatment should aim at optimal care and must be based on a shared decision between patient and rheumatologist.
The optimal management of patients with AS requires a combination of non-pharmacological and pharmacological treatment modalities (Braun, 2011)
The goal of treatment for AS is to control and manage both the inflammation and the symptoms. Control of inflammation helps limit deformity and control of symptoms helps prevent social isolation often associated with this condition. Less inflammation also allows AS patients to move more, and movement is a part of every treatment plan. Factors that can affect the course of treatment are, of course each patient’s symptoms, but also their unique manifestations, prognostic factors, age, sex, comorbidities, and current medications.
Ongoing history taking, lab testing, clinical testing, and imaging should be performed to monitor AS. Non-pharmacological treatment options include patient education, home exercise, and supervised exercise. Supervised exercise is preferred over home exercise. Pharmacological treatment options are also available and should be discussed with a Rheumatologist and Pharmacist.
AS can be a challenging disease both physically and mentally. Finding the right support system with knowledge and expertise when dealing with AS is a huge asset. There is also research that shows joining a support group or AS association can be of great benefit as well.
For more information, take a look at the most recent consensus by Braun (2011) or send us an email at hello@madetomove.ca.
