With P. Bradley Segebarth, MD
A form of arthritis that primarily affects the spine, ankylosing spondylitis causes inflammation of the joint.
Even if you or a loved one are not affected by ankylosing spondylitis, many have become familiar with the disease as the affliction Imagine Dragon’s Dan Reynolds and Motley Crue guitarist Mick Mars have battled the majority of their lives.
The inflammation of the vertebrae (or spinal joints) can cause extreme pain or discomfort. A progression of the disease can find sections of the spine immobile and fused together. While the spine is most commonly affected, other joints can be as well from hips to shoulders.
NOT A STRAIGHT-FORWARD DIAGNOSIS
“AS can be challenging to diagnose early in the disease process because symptoms can be subtle, consisting of just stiffness or non-specific pain even without activity,” says OrthoCarolina’s Dr. Brad Segebarth, a fellowship trained spine surgeon.
Family history and the presence of the HLA-B27 genetic marker can be indicators.
“There are no great labs to pinpoint the diagnosis, although some genetic markers may be helpful,” Dr. Segebarth said. “Ultimately, the diagnosis comes down to a thorough history, exam and imaging studies by an experienced provider.”
TREATMENT AND LIFESTYLE
While there is no known cure for AS, treatment often consists of medications such as anti-inflammatories or immunosuppressives as well as physical therapy and exercise.
“This is a condition that is best treated early before joint damage has occurred,” Dr. Segebarth said. “If damage has progressed or is disabling, orthopedic procedures such as hip replacement or spine surgery can be helpful.”
It is very important to stay active. Stretching and exercise help reduce joint pain and maintain good posture. Other factors such as smoking cessation are also important to maintain optimal respiratory capacity, as the chest wall can stiffen.
ADVANCED RISK FOR BREAKS AND FRACTURES
With ankylosing spondylitis, the spine is stiff but the bones are more brittle than usual putting patients at risk for a fracture or break in the spine even with a low energy injury such as a fall from standing.
“Any patient with AS who has an injury that is painful in the back or neck should be evaluated with advanced imaging (CT scan or MRI),” Dr. Segebarth said. “A subtle fracture is often missed on simple X-ray and could lead to serious problems due to the inherently unstable nature of a fracture in the setting of a stiff spine.”
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