Summarizing the symptoms
AS generally comes on gradually, as pain or stiffness settles into the lower back or hips, and the places where tendons and ligaments attach to the spine. Problems can also develop with the neck, shoulders, hips, knees, and back of the heel. The pain may be worse at night or upon arising, then recede once the person begins to move around. AS symptoms can be fairly constant or come and go.
A systemic disease, AS can cause compression fractures to the vertebrae, eye problems, loss of appetite, fatigue, and fever. There may also be difficulty in taking a deep breath, damage to the aorta (the body’s largest artery), and problems caused by pressure on the nerves.
Diagnosing and treating ankylosing spondylitis
No one, single test can detect AS, so diagnosis is usually made from a combination of symptoms and family history, a physical examination, blood tests showing inflammatory markers and/or the HLA-B27 gene, and MRIs or X-rays, which can reveal characteristic joint damage or extra bone in the spine or sacroiliac joints of the pelvis.
Treatment is aimed at relieving pain and inflammation and preventing or correcting deformities of the spine to preserve spinal flexibility. NSAIDs are prescribed to ease inflammation, pain and stiffness. But one of the most exciting developments in rheumatology over the last few years is the effectiveness of biologics in treating ankylosing spondylitis, including tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira) and etanercept (Enbrel), and interleukin-17 (IL-17) inhibitors such as secukinumab (Cosentyx) and ixekizumab (Taltz). These and other biologics have been found to improve mobility and possibly fight the progression of AS (you can read more about them in Chapter 8).
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