Ankylosing spondylitis

It is an inflammatory disease of the spine that affects the sacroiliac joints in all cases. Its natural evolution is towards ankylosis of the spine with the consequent loss of elasticity of the spine. It occurs most frequently between the ages of 20 and 40. The average age of onset is 27 years, predominantly in males. Onset after 45 or before 9 is exceptional.

How is it produced?

The cause is unknown, although the relationship between this disease and the HLA-B27 antigen, transmitted by genetic inheritance, is known. It is also thought that there are other determining factors in the disease, such as an alteration in the immune response, an infectious agent or others that are still unknown.

The involvement of the sacroiliac joint (union between the sacrum and the pelvis) is constant and from this, the inflammation occurs in an ascending way by the spine with a tendency to the fusion of the vertebral bodies through bone proliferations (syndesmophytes) originating the so-called "Solomonic" or "bamboo cane" column in advanced forms.

Symptoms

In most cases the onset is insidious with mild or moderate discomfort in the spine, reaching diagnosis approximately 3 years after the onset of symptoms.

The main symptom is pain, most frequently in the lumbar area, characteristically waking up the patient, forcing him to get up and walk for a few minutes or to repeatedly change posture. This pain is not related to exertion and alternates with periods without pain. Lumbar stiffness is also frequent, predominantly in the morning that improves with physical activity. Both aspects alternate with periods of remission until the appearance of new outbreaks of pain and / or stiffness.

respiratory involvement is due to involvement of the manubriosternal, chondrosternal and sternoclavicular joint and can be in the form of chest pain as a presentation. Peripheral joint alterations occur in half of the patients. The most important is that of the hips, which is chronic, generally bilateral and often causes significant disability.

Among the extra-articular manifestations of ankylosing spondylitis, ocular involvement in the form of acute iritis stands out. It is a form of uveitis that appears at least once in 30% of patients. It appears in the form of pain and photophobia. It does not usually leave sequelae and is usually unilateral. At the cardiac level, aortic involvement is the most characteristic, in the form of insufficiency, and pulmonary involvement is due to altered respiratory mobility causing dysfunctions in functional tests. There is also some instability in the cervical spine when it is affected, causing cervical cord injuries and cervical dislocations.

Diagnosis

It is based on clinical and radiological data, forming part of some universal criteria in which the involvement of the sacroiliac joint is decisively included. Sacroiliitis is classified into different degrees based on the radiological alterations observed and together with clinical criteria that include limitation of lumbar spine movements, pain in the lumbar region and decreased respiratory expansion, constitute the diagnosis of the disease.

Among the laboratory tests, the presence of the HLA-B27 antigen stands out in 90% of patients, although its presence alone is not indicative of disease. It is a piece of information that can help the diagnosis. ESR is increased as a nonspecific inflammatory sign in most patients, unrelated to disease activity.

Treatment

There is no curative treatment. It is based on reducing pain and stiffness and avoiding ankylosis of the spine and peripheral joints, keeping the patient with the highest possible quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) allow pain relief and thus avoid bad posture. Treatment should be prolonged with the lowest possible doses to achieve good pain control and achieve regular exercise. sulfasalazine may be useful in people who do not respond to NSAIDs and in forms of not many years of evolution.

It is a disease in which complete rest is contraindicated, due to its great tendency to ankylosis. It is advisable to perform exercises that allow a good extension of the back, such as swimming. It is important that the patient is trained in the practice of exercises to avoid ankylosis by professionals to do them later at home on a daily basis.

Corsets are not recommended because they favor immobilization of the spine, and hard mattresses, with a board underneath, and thin pillows are.

In this way, the evolution of the disease is good. Only a minority will evolve unfavorably despite the medical and rehabilitative treatment used. Rigidity is the most common sequel, causing a reduction in the functional capacity of the patient.