Ankylosing Spondylitis (AS) is an inflammatory disease affecting mainly the pelvic (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.
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 become weak and numb if certain nerves are pinched or trapped but this is very rare.
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. Ossification causes new bone to grow 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 very rare.
Case history and Examination
The chiropractor will first of all review your general health and family medical history. It is important for the chiropractor to know if any family member has had the problem.
A family history of Ankylosing Spondylitis may be indicative in diagnosing this condition, but it is not necessary.
During the physical examination, you will be asked to move and bend in different ways so the chiropractor can see how flexible your spine is.
In the early stages subtle changes can be significant. In a later stage the mobility can be significantly reduced.
The chiropractor will also check your chest expansion which can be reduced in AS.
The chiropractor will also do a neurological examination.
If the findings in the history taking and examination suggest that you may have AS, the chiropractor will take X-rays.
The signs on X-rays are usually quite characteristic and if the findings correlate with the history and examination, a diagnosis can often be made with good accuracy.
There are very characteristic signs on x-rays that the chiropractor can look for.
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.
When it comes to diagnosing a medical condition, one or a collection of symptoms can have many causes.
For example in AS, the most common presentation is pelvic (sacroiliac) joint pain from inflammation of the sacroiliac joint. Sacroiliitis (inflammation of the sacroiliac joint) can have many causes.
It can be caused by Psoriatic arthritis, Reiter’s syndrome, Ulcerative colitis or infection, to mention a few.
But by doing various tests one or the other condition can be ruled out. This is of course important so the most appropriate treatment can be given.
The 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 of a kind that is safe and comfortable for you.
Because chiropractors specialise in treatment of lower back pain and usually have X-ray facilities on-site we often pick up when patients have AS early on.
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 several patients over the years that have found that chiropractic treatment has maintained their mobility, improved their function and therefore helped to control their pain.
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 the ISIS Chiropractic Clinics 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
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