 |
| Dr Weriwoyingipre Silver Yeibake |
Mr Abiye is a 35-year-old civil engineer in Port Harcourt who spends long days on construction sites bending, lifting, and driving between projects. Over the last year, he began waking up with a deep, dull ache in his lower back. Mornings were the worst—he felt stiff and slow to move, but after a bit of walking, the pain softened. He blamed long shifts and heavy work at first. Then, his neck stiffened and his chest felt tight during busy weeks. That pushed him to see a doctor.
What is Ankylosing Spondylitis?
Ankylosing spondylitis (often misspelled as ankylosing spondylosis, or abbreviated as AS) is a long-term inflammatory disease that mainly affects the spine and the sacroiliac joints—the places where the spine meets the pelvis (hip bone). Inflammation causes pain and morning stiffness and, over years, can reduce spinal flexibility. In some people, new bone formation may bridge the vertebrae (the smaller bones that combine to make up the backbone), limiting or reducing movement. AS most commonly starts in young adults (from their teens to their 40s) and is more prevalent in men.
How it Started for Mr Abiye: The Usual Signs
- Persistent low back pain and stiffness: Especially in the morning or after periods of rest.
- Pain that improves with activity: Gentle activity eases the discomfort, whereas inactivity worsens it—a useful clue that this is inflammatory rather than simply “mechanical” back pain.
- Disrupted sleep: Pain or stiffness that wakes you during the second half of the night.
- Neck stiffness and chest tightness: Particularly when taking deep breaths.
- Radiating pain: Pain spreading to the buttocks or hips, tendon pain (such as heel pain), and sometimes swelling in other joints.
- Eye symptoms: A minority of patients experience red, painful, or light-sensitive eyes due to inflammation (uveitis).
- General systemic effects: Fatigue and reduced sleep quality are common.
What Causes It?
Doctors do not yet know a single definitive cause. What is known is that it develops due to an interaction between genetics and the environment. The key points are:
- Genetics: Many people with AS carry a gene called HLA-B27, which raises the risk but does not guarantee the disease will develop.
- Immune system: The immune system mistakenly drives chronic inflammation in susceptible people.
- Environment and lifestyle: Smoking, certain infections, and a delayed diagnosis can significantly worsen outcomes.
How Doctors Make the Diagnosis
Diagnosis combines a detailed medical history, a physical examination, blood tests, and imaging:
- Medical history: Looking for a pattern of morning stiffness, symptom improvement with movement, and night pain.
- Physical examination: Checking for limited chest expansion, reduced forward and sideways spine movement, and tenderness when touch is applied to the sacroiliac joints.
- Blood tests: Checking for the HLA-B27 gene and elevated inflammatory markers (such as ESR and CRP) can support the diagnosis, though they are not definitive on their own.
- Imaging: X-rays may show sacroiliitis or later structural changes, while an MRI is sensitive enough to detect early-stage inflammation.
A rheumatologist usually makes the final diagnosis and guides long-term care.
Treatment: What Helped Mr Abiye
The goals of treatment are to control pain and inflammation, protect posture, preserve mobility, reduce disease progression, and keep individuals working and active.
Medications
- NSAIDs: Non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen) are the first-line treatment for pain and stiffness.
- Biologics: If NSAIDs are insufficient, biologic disease-modifying anti-rheumatic drugs (for example, TNF inhibitors or IL-17 inhibitors) are used to reduce inflammation and slow disease progression.
- Steroids: Short courses of oral steroids are sometimes used to manage acute flares, while local steroid injections can help ease persistently painful joints.
- DMARDs: Other non-biologic drugs (like sulfasalazine) may help if the disease affects peripheral joints.
Exercise and Physiotherapy
- Daily exercises focusing on posture, spinal extension, chest expansion, and core strength are essential.
- Physiotherapists teach posture-correcting techniques, workplace stretches, and supervised strengthening routines.
- Swimming and walking are excellent low-impact activities.
Lifestyle Measures
- Maintain an active lifestyle and avoid prolonged sitting or slouching.
- Smoking cessation is critical: Smoking speeds up disease progression and reduces the body's response to treatment.
- Maintain good sleep posture and use a firm mattress.
- Implement ergonomic workplace changes, including supportive seating, proper lifting techniques, and frequent movement breaks.
Ongoing Care
- Regular reviews by a rheumatologist, eye checks if symptomatic, and routine physiotherapy follow-ups.
- Vaccinations and infection prevention become highly important when using immunosuppressive drugs.
Complications to be Aware Of
- Spinal fusion: Advanced disease can cause the vertebrae to fuse together, severely reducing mobility.
- Postural changes: A forward-stooped posture may develop if posture is not actively protected.
- Reduced chest expansion: Fusion or stiffness in the ribs can limit deep breathing, increasing the risk of chest infections.
- Eye inflammation (uveitis): A painful, red eye condition that requires urgent specialist treatment to prevent vision loss.
- Peripheral joint damage: The hips and shoulders can be affected and may require surgery in severe cases.
- Osteoporosis and spinal fractures: Chronic inflammation and reduced mobility increase the risk of bone thinning and fractures.
- Cardiovascular disease: There is a slightly higher risk of heart problems over time due to chronic systemic inflammation.
- Emotional impact: Managing chronic pain and potential disability can affect mental health, sometimes leading to depression and anxiety.
Prevention and Control: Practical Steps
- Early diagnosis and treatment: The sooner inflammation is controlled, the better the long-term outlook.
- Stay active: Daily stretching and strengthening exercises preserve posture and physical function.
- Quit smoking: This single step slows disease progression and improves response to medical therapies.
- Maintain a healthy weight: This reduces mechanical strain on the joints and spine.
- Workplace adjustments: Use mechanical aids, avoid prolonged stooping, and take regular micro-breaks.
- Regular medical follow-ups: Monitor for complications and adjust therapy as needed.
- Eye care: Seek prompt medical treatment for any eye pain or visual changes.
Common Myths and Facts
- Myth: “Back pain that goes away with movement is not serious.”
- Fact: Pain that improves with movement is a hallmark of inflammatory back pain (like AS) and should be evaluated by a professional.
- Myth: “Only old people get spinal diseases.”
- Fact: AS characteristically starts in young adults and can progress severely without early intervention.
- Myth: “Surgery is always needed.”
- Fact: Most people manage AS effectively with medications, exercise, and lifestyle changes; surgery is reserved for specific, severe complications.
- Myth: “If I test positive for the HLA-B27 gene, I will get AS.”
- Fact: The HLA-B27 gene raises your risk, but many people who carry the gene never develop the disease.
- Myth: “Exercise will make my condition worse.”
- Fact: Regular, appropriate exercise is one of the best ways to maintain mobility, protect posture, and reduce symptoms.
When to Seek Urgent Care
Go to the hospital immediately if you experience:
- Sudden, severe back pain after a fall or trauma.
- A sudden painful, red eye, or abrupt vision changes.
- New or worsening breathlessness, or sharp chest pain.
- Sudden weakness, numbness, or loss of bladder or bowel control (as these can signal nerve compression).
Living Well Long-Term: Mr Abiye’s Plan
Mr Abiye started daily morning stretches, committed to regular physiotherapy sessions, and made simple workplace changes. He now alternates between sitting and standing, uses proper lifting techniques, and schedules short stretching breaks while on site. He successfully quit smoking and discussed a biologic option with his rheumatologist when NSAIDs didn’t fully control his symptoms.
With this combined approach of targeted medication, daily exercise, and regular follow-up care, he has preserved his ability to work, improved his posture, and regained his comfort.
If you are experiencing symptoms similar to Mr Abiye’s—such as long-standing morning stiffness, back pain that improves with movement, or waking up in the night due to discomfort—please see your family doctor or a rheumatologist. Early action drastically improves long-term outcomes.
References
- Brown, M.A., et al. “Ankylosing spondylitis” in The Lancet, 2020; providing a comprehensive overview of pathophysiology and treatment advances.
- Rudwaleit, M., et al. “The Assessment of SpondyloArthritis International Society (ASAS) Handbook”—diagnostic criteria and management guidance.
- Sieper, J., et al. “Management recommendations for ankylosing spondylitis” (ACR/EULAR/Spondyloarthritis guidelines), 2019–2023 updates.
- National Rheumatology or Arthritis organisations’ patient guides: Arthritis Foundation (arthritis.org) and Spondylitis Association resources.
- UpToDate: Clinical reviews on ankylosing spondylitis (subscription-based medical resource).
0 Comments