"The HLA B27 gene is a predisposition factor and not a single factor. In fact, there are many people who have this gene and do not suffer from ankylosing spondylitis".
DR. EUGENIA ENRÍQUEZ MERAYO
SPECIALIST. RHEUMATOLOGY SERVICE
Ankylosing spondylitis is an inflammatory disease that primarily affects the spinal joints, which tend to weld together, reducing their flexibility and producing a stiffness of the spine.
It belongs to the group of rheumatic diseases called spondyloarthropathies.
It is a disease of young people and affects men more often than women.
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What are the symptoms of ankylosing spondylitis?
Pain in the spine can occur at any level, but the initial symptoms are usually low back pain accompanied by a predominantly morning stiffness that improves with physical activity or throughout the morning. The symptoms of inflammation of the sacro-iliac joints usually are pain in region gluteus frequently bilateral and of nocturnal predominance (in the bed).
One third of the patients have asymmetric peripheral arthritis, affecting mainly the shoulders, hips, knees, back of the foot (tarsus) and toe joints. These patients also tend to present pain in the chest due to inflammation of the joints between the sternum and the ribs and clavicles, which over time produces a limitation of the mobility of the chest, and "enthesopathy" (inflammation) more frequently in heels, patellar region and Achilles' tendon. Among the extra-articular manifestations may present, inflammation of the iris (iritis or uveitis) especially those with HLAB27.
In 3.5% of patients with long-term disease there is inflammation of the aorta (aortitis), kidney involvement (secondary to the toxicity of anti-inflammatory drugs or by the development of a disease called amyloidosis).
The most common symptoms are:
- Pain in the spine and joints.
- Loss of mobility.
- Spinal stiffness.
- Ocular inflammation.
Do you have any of these symptoms?
You may have ankylosing spondylitis
How is ankylosing spondylitis diagnosed?
There are some criteria for the diagnosis of ankylosing spondylitis that include, in addition to clinical criteria (low back pain for more than 3 months that improves with exercise but is not relieved with rest, limitation of thoracic expansion and mobility of the lumbar spine), radiological criteria such as radiological evidence of inflammation of the sacroiliac joints (sacroilitis).
Ankylosing spondylitis is considered defined if there is both clinical and radiological criteria. And probable ankylosing spondylitis, when there are three clinical criteria or one radiological criterion.
Blood and urine tests can help support the diagnosis by the presence of HLA-B27 antigen in the blood, or can determine the greater or lesser intensity of the inflammatory process suffered by the patient.
How is ankylosing spondylitis treated?
Treatment aims to reduce joint pain and stiffness, as well as prevent ankylosis and deformities. It is based on two main axes: non-steroidal anti-inflammatory and physiotherapeutic treatment.
Among the most widely used anti-inflammatory drugs (NSAIDs) are Indomethacin, Naproxen, and Diclofenac. These can be combined with the so-called disease modifying drugs (methotrexate, sulfasalazine, leflunomide,...). If there is no response, or intolerance or toxicity occurs, therapy is usually initiated with anti-TNF drugs (infliximab, etanercept, adalimumab).
Physiotherapy treatment is a basic pillar and must be individualized for each patient. It is very important to avoid prolonged rest or the application of corsets or braces that immobilize the spine. The ideal sport is swimming. In some cases, local infiltration with corticoids is indicated.
The surgical treatment is only used in few occasions when the joints are very damaged and the mobility has been lost or the pain is untreatable.
Where do we treat it?
IN NAVARRE AND MADRID
The Rheumatology Service
of the Clínica Universidad de Navarra
The Rheumatology Service has a multidisciplinary team highly specialized in the diagnosis and treatment of rheumatological diseases, from osteoarthritis, arthritis or osteoporosis to autoimmune or inflammatory diseases.
In addition, we have doctors specialized in assisting pregnant women with autoimmune diseases, in order to guarantee the maximum safety of the fetus.
Organized in specialized units
- Inflammatory arthropathies.
- Degenerative arthropathies.
- Microcrystalline arthropathies.
- Bone pathology.
- Systemic autoimmune diseases.
- Autoinflammatory diseases.
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- Valoración integral del paciente.
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