Ankylosing spondylitis (AS)
is a chronic condition that
is commonly misdiagnosed
as mechanical back pain. Its
low prevalence means many
people, including healthcare
professionals, have a lack of familiarity and
knowledge, which prevents AS patients
from getting proper treatment early.
AS is an arthritic condition caused by
the immune system attacking one’s own
body. It begins with inflammation
around the bones in the spine or
joints. There is pain and stiffness
in the back, neck and sometimes
hips and heels. It can also
produce eye problems, skin
rashes and/or gastrointestinal
symptoms in some cases. People
afflicted with AS may also feel
feverish and fatigued.
AS can make it hard to do simple
things, such as getting dressed, getting up
from a sitting position and looking from side
to side. If the bones in your spine have fused
together, you could be at risk of serious neck
or back injury.
Though it can affect anyone, AS
development has a genetic predisposition.
The prevalence of AS parallels that of
HLA-B27, a gene that increases the
individual’s susceptibility of getting the
condition. Onset of AS usually occurs in the
teenage years, but it can begin in people up
to around 50 years old. Globally, it is more
common in males than females.
The pain usually starts in early adulthood,
before age 40, comes on slowly and lasts
for over three months. It feels better with
movement and is worse after resting. The
back may also become less flexible, making it
harder to bend forward.
There is no single test for ankylosing
spondylitis, said Dr Stanley Angkodjojo (above),
Consultant, Rheumatology, Department of
General Medicine, Sengkang General Hospital.
“But your doctor or nurse should be able
to tell if you have it by learning about your
symptoms, doing an examination and using
imaging tests like x-rays to look at your bones
and joints.” A blood test can also be conducted
to look for the presence of the HLA-B27 gene.
Knowledge is power
Awareness of the AS condition can lead to
a more timely diagnosis for those suffering
from backaches and joint pains, and better
control of the condition.
According to a local study, the mean
disease duration before the actual diagnosis
of AS is about 10 years. Such delays mean
AS patients suffer for years before getting
appropriate help. It also affects their quality
of life, with some even developing depression
because they do not have the right tools and
knowledge to monitor their symptoms.
“Knowledge can empower people to
continue consulting with the right physicians
until their condition is properly managed and
disease progression can be delayed. Patients
diagnosed with AS should speak to their
doctor about the latest treatment options. It is important for patients to partner with doctors
to understand the disease in-depth and be
informed about how the condition can be
better managed to enable an enhanced quality
of life,” said Dr Angkodjojo.
For those who are genetically predisposed,
prevention may not be possible, but they can
take steps to prevent complications and feel
better while living with the condition. Correct
treatment and lifestyle changes can help
relieve symptoms, thus allowing them to do
everyday activities and keep their condition
from causing other problems.
Exercise is an important part of treating
AS. Stretches and gentle exercises can
strengthen the muscles and prevent some
of the stiffness. It is especially important to
work on posture because AS can cause the
head to tilt forward in a hunchback posture.
Quitting smoking helps. Smokers with
ankylosing spondylitis may be more likely to
have breathing problems. Smoking can also
worsen AS and makes the condition harder
to control. Meanwhile, consuming plenty
of calcium and vitamin D helps keep bones
from getting weak.
AS patients may be prescribed nonsteroidal
anti-inflammatory drugs to relieve
pain and stiffness. Biologics, which are
genetically engineered proteins created
from living organisms that mimic normal
biological functions, are another option. This
type of targeted therapy is aimed at specific
proteins in the immune system that cause
inflammation, and can reduce back pain and
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