Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine, causing significant pain, stiffness, and reduced mobility. While severe, long-standing AS can lead to profound mobility impairment requiring a wheelchair, this is not a common outcome. Modern treatments and early diagnosis significantly reduce the likelihood of such severe disability.
Understanding Ankylosing Spondylitis and its Impact on Mobility
Ankylosing spondylitis is a type of arthritis that causes inflammation in the spine and large joints. This inflammation typically begins in the sacroiliac joints, located at the base of the spine where it connects to the pelvis, and can progress up the spinal column.
Over time, chronic inflammation can lead to new bone formation, causing vertebrae to fuse. This process, known as ankylosis, makes the spine less flexible and restricts movement. As the disease advances, it can lead to a hunched posture and a stiff, inflexible spine.
AS can also affect other large joints, such as the hips, shoulders, ribs, and heels, further contributing to pain and limited range of motion. Stiffness and pain often worsen during periods of rest, particularly at night or in the morning, and may improve with activity.
Factors Influencing Disease Progression
Several factors influence the progression and severity of ankylosing spondylitis. Genetic predisposition plays a significant role, with most individuals affected by AS possessing the HLA-B27 gene. However, not everyone with this gene develops AS.
Symptoms often begin between ages 20 and 40. Delays in diagnosis can allow inflammation to cause more structural damage before treatment. The presence of other symptoms, such as inflammation in peripheral joints (hips or shoulders) or extra-articular manifestations like eye inflammation (uveitis) or inflammatory bowel disease, can indicate a more widespread or severe disease course.
Complications That Can Lead to Severe Disability
Though less common with current treatments, specific complications of ankylosing spondylitis can lead to severe mobility impairment. One complication is extensive spinal fusion, often called “bamboo spine,” where multiple vertebrae fuse into a single, rigid column. This results in extreme stiffness and a fixed, forward-curved posture (kyphosis), severely limiting back movement.
Severe hip joint involvement can significantly impact ambulation, sometimes requiring hip replacement surgery to restore function. The rigid spine in advanced AS is also more susceptible to spinal fractures, even from minor trauma, which can lead to neurological deficits and severe pain. In rare instances, fusion of the rib cage can restrict lung capacity, making deep breathing difficult. When these severe outcomes occur, mobility devices like wheelchairs may be necessary to support daily activities and maintain independence.
Strategies for Maintaining Mobility and Quality of Life
Proactive measures and interventions are key for preventing or mitigating severe disability and preserving mobility in individuals with ankylosing spondylitis. Early diagnosis allows for prompt initiation of treatment to manage inflammation and slow disease progression.
Treatment often begins with non-steroidal anti-inflammatory drugs (NSAIDs), which help reduce pain and inflammation. Biologic therapies, such as TNF inhibitors and IL-17 inhibitors, have improved outcomes by targeting inflammatory pathways to control the disease. These medications manage symptoms and help prevent structural damage to the spine and joints.
Alongside medication, physical therapy and regular exercise are fundamental to maintaining flexibility, strength, and posture. Exercises focusing on stretching, aerobic conditioning, and postural training can reduce pain, increase spinal mobility, and prevent deformities. Hydrotherapy, or exercise in water, can also be beneficial due to water’s buoyancy and warmth, which support movement and relax muscles.