Ankylosing spondylitis (AS), otherwise known as Bechterew’s disease, is a type of inflammatory arthritis that primarily affects the spine and causes back pain. Ankylosing spondylitis is also referred to as radiographic axial spondyloarthritis (axSpA).
During the progression of ankylosing spondylitis, the condition can cause fusion of the spine. This is characterized by the vertebrae (spine bones) growing together, resulting in less flexibility, a hunched-forward posture, and — if the ribs are affected — difficulty breathing. Some of the changes that come with AS require an imaging device (such as an X-ray) to see, while others — including eye inflammation — are apparent and visible.
Physicians, such as rheumatologists, use several different forms of imaging techniques to monitor AS disease progression. For instance, X-rays can be used to visualize malformations of the spine. X-rays, also called radiographs, use radiation to take pictures of bones and other materials that are harder than soft tissue, like skin and organs. Magnetic resonance imaging (MRI) is also used.
Radiography is the conventional method for assessing structural damage in spine and sacroiliac joints (joints that link the spine and pelvis) in individuals with AS. MRI has gained a prominent role in monitoring disease activity during clinical trials and regular clinical practice. Radiography and MRI are useful in monitoring the disease progression of AS and can complement each other well when used together.
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Erosion and ankylosis (immobility due to fusion) of the sacroiliac joints are the hallmarks of AS, and X-rays are commonly used to visualize disease progression in this area of the body. Additionally, early radiographic signs of AS in the spine are most often due to inflammation (enthesitis).
Computed tomography (CT) and ultrasonography are also sometimes used, but each have their drawbacks. For example, CT scans use large amounts of radiation and do not assess damage to soft tissues well.
Ankylosing spondylitis isn’t always apparent in the beginning stages. However, at some point, changes to the spine structure, like kyphosis, can become apparent to the naked eye.
Kyphosis is a forward curvature of the spine in the upper back area, which gives an abnormally rounded or “humpbacked” appearance. The spine can normally bend up to 45 degrees; kyphosis is defined by curvature greater than or equal to 50 degrees on an X-ray.
Other inflammation-related changes can occur in a person with AS. For example, the middle layer of tissue in the eye wall — called the uvea — can become inflamed. This is known as anterior uveitis, the symptoms of which include redness, pain, and blurred vision.
Emotional Impact of a Changing Body
Living with a spine that is curving can be difficult. Among members of MySpondylitisTeam, pain is a common experience for those with AS and spine curvatures. One member wrote, “I have some kyphosis in my thoracic spine, but my neck looks horrendous. The inward curvature is so much worse due to my neck curving, so I can still look straight ahead! It looks so painful.” Another member wrote, “My spine is starting to curve! I have been in so much pain. Everything HURTS!”
Pain is not only physically exhausting; it is mentally taxing too. Research shows that chronic pain is associated with worse mental health outcomes, particularly for depression and anxiety. However, more research is needed to specifically understand how spine pain impacts the quality of life in those with AS long-term.
Learn more about how spondylitis can affect your mental health.
Some medications can slow the progression of AS and prevent some of the damage to the spine. Currently, there are several medications approved by the U.S. Food and Drug Administration (FDA) to slow disease progression and prevent joint damage.
Beyond taking your AS medications as prescribed, there are several other things you can do to help facilitate a healthy posture. For instance, physical therapy can provide a number of benefits, including pain relief, improved strength, and increased flexibility.
Additionally, range-of-motion and stretching exercises — including yoga poses — can help maintain flexibility in your joints and preserve good posture. In general, practicing good posture can help.
The American Chiropractic Association has a number of tips for improving posture. Some of these include:
One member of MySpondylitisTeam recommends a back brace for helping with posture and reducing low back pain.
MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 72,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.
Are you living with ankylosing spondylitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.