Ankylosing Spondylitis (AS) is an inflammatory disease affecting mainly the pelvis (sacroiliac) joints, spine and rib joints, causing pain and progressive stiffness. It affects young males about four times as often as females. Onset typically occurs between the ages of 15 and 45.
Symptoms Of Ankylosing Spondylitis
The main presenting complaints in the early stages are lower back pain with morning stiffness that often wares off during the day with activity. In some cases the inflammation can be so severe that the pain is constant and severely disabling, but this is rare.
The pain and stiffness can progress to affect the mid back and neck, and in about a quarter of people with AS it affects the joints in the limbs, with the hips being the most common, affecting half the people with AS.
If the chest and ribs are affected, it can make it difficult to take a deep breath. The legs can occasionally become weak and numb if certain nerves are pinched or trapped.
What Is Ankylosing Spondylitis?
The exact cause is not fully understood but it is classified as an autoimmune disorder, which means that the body’s immune system is attacking some of its own cells causing ongoing inflammation. It is classified as one of the so-called sero-negative arthropathies (the rheumatoid factor is not present).
As it progresses, ossification is triggered by the body’s defense mechanism. New bone grows along the ligaments between vertebrae gradually limiting movement and eventually fusing them together. Further, ossification may affect spinal ligaments causing narrowing of the spinal canal (central stenosis), which can result in compression of nerves but this is quite rare.
The signs on X-rays are usually quite characteristic.
In the early stages there is a widening of the pelvic (sacroiliac) joints (SI) with irregularity of the joint surface and sclerosis (whitening of the bone). There may be squaring of the vertebrae and mild calcification of the outer part of the discs (causing what is called ‘shiny corner signs’ and syndesmophytes).
In the later stages when the condition has been present, usually for many years, fusion may occur causing a so called ‘bamboo spine’.
A CT- or MRI-scan may be ordered to see the spine in greater detail, especially if the X-rays do not correlate with the findings in the history and examination.
However, we would inform your GP and normally suggest that you have blood tests taken to support the diagnosis.
A blood sample is taken to look for an antigen called HLA-BA27, which is positive 96% of the time. But the presence of HLA-BA27 does not mean that you have AS for sure. It is just an indicator that you may have it. (An antigen is a protein that helps the body to make antibodies to fight infection.)
Blood tests are usually negative for rheumatoid factor, which will rule out Rheumatoid arthritis.
ESR is usually raised. This is an indication that your body is fighting an inflammation.
Chiropractic Treatment Of AS
Because chiropractors specialise in treatment of lower back pain we often pick up when patients have AS early on.The medical treatment includes nonsteroidal anti-inflammatory medication and physical therapy. Unfortunately, in some cases patients in past have been told by their medical practitioner that chiropractic treatment is not appropriate for them. But it is important to know that chiropractic treatment is a very helpful, safe and effective way of managing your AS.
We have had many patients over the years that have found that chiropractic treatment has maintained their mobility, improved their function and therefore helped to control their pain.
Your chiropractor will show you exercises designed to strengthen your back, improve posture, increase flexibility, range of motion, and techniques to improve your breathing. We normally also use spinal manipulation and spinal traction of a kind that is safe and comfortable for you. There is no doubt that anti-inflammatory medication will help if the inflammation is particularly bad. So, ideally you should be co-managed. Which means that your GP and/or rheumatologist and chiropractor should both be involved. At Total Health Chiropractic we encourage co-operation between medical and complementary practitioners to give you the best possible care.
Here is some research for you if you want to read further.
Links to research:
Ankylosing Spondylitis and Chiropractic Care.