Ankylosing spondylitis (AS) affects between 150,000 and 300,000 Canadians, and three times more men than women. The disease usually sets in between the ages of 15 and 40, but more specifically in young patients aged 15-30. The disease rarely presents in people over age 40.

What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly attacks the spine, although the hips, shoulders, knees, ankles and feet, and organs such as the eyes, lungs, bowel and heart can also be affected. It can also affect the tendons and ligaments connecting to and supporting the spine.

How does AS affect the spine?
This type of arthritis presents as relatively intense flare-ups that can be widely spaced out and highly variable. Moreover, AS is characterized by severe pain and stiffness in the lower back. This pain can be caused by inflammation of the vertebrae and pelvis. As the disease progresses, the joints and bones in the spine can fuse together, becoming rigid and immobile, although complete fusion is very rare. As a result, if the inflammation associated with AS is not controlled, it can worsen and cause spinal deformities.

While we do not yet know the precise cause of the disease, AS appears to have a hereditary component.

What are the symptoms?
Here are a few of the most common symptoms of AS. These symptoms can vary, and some can persist for more than three months.

• Pain or stiffness in the lower back, mainly in the morning or after a period of inactivity
• Weight loss
• Decreased appetite, especially at the start of the disease
• Fatigue
• Fever
• Occasional inflammation of the eyes and/or heart valves

Treatments
Currently, there is no cure for AS. Accordingly, treatment mainly aims to relieve the pain as effectively as possible, and maintain joint mobility and function. Early diagnosis by a physician is crucial, since the earlier appropriate treatment is administered, the fewer the chances that deformities will develop which can lead to disability.

The objectives of treatment are to decrease inflammation and pain, and avoid complications.

Non-steroidal anti-inflammatories (NSAIDs) or conventional anti-inflammatories are still the first-line treatment for the pain and stiffness associated with AS. As such, they are the drugs most often used and comprise the basis of treatment. However, these drugs can only help relieve the pain and discomfort caused by the inflammation and stiffness; they cannot prevent the damage that can develop in the joints.

Remission agents are usually used as second-line treatment. These drugs can be used to slow and control the progress of the disease in people seriously affected. They can sometimes even prevent the AS from worsening. However, it can take 2-6 months before they start to work.

Physicians may also prescribe cortisone, a corticosteroid anti-inflammatory stronger than NSAIDs. It can be prescribed in oral form or injected directly into a joint. Ideally, corticosteroids should only be used for a limited time, since they can cause adverse effects.

Biological agents are the newest drugs to be used when the other treatments have failed to give the desired results or when the patient does not tolerate conventional treatments. These drugs can decrease the signs and symptoms of AS, such as inflammation and pain.

Finally, physical activity is the most important part of treatment. Exercise helps maintain mobility and flexibility, and can also reduce the pain. Maintaining good posture will help avoid the complications of AS, such as stiffness and spinal deformities. Back and abdominal exercises help maintain and improve posture. Breathing techniques are also excellent for improving pulmonary function. Swimming, for example, is a good exercise for people with AS. In short, physical therapy is key to improving the symptoms and fighting bad habits.