Ankylosing spondylitis is an inflammatory process of the vertebral joints, resulting in stiffness. About one in a thousand people will be affected by this disease. It occurs equally often in men and women. Heredity seems to play a major role in this. Stiffness and pain is a common complaint, as is fatigue. This disease is sometimes confused with Reiter’s disease/syndrome because many symptoms are similar.

What is Ankylosing Spondylitis?

Ankylosing spondylitis belongs to the rheumatic diseases. Rheumatic diseases are complaints and abnormalities of the musculoskeletal system. In ankylosing spondylitis, the vertebral joints (neck and back) and the pelvic joints in particular are inflamed. But the hips, knees and shoulders can also become inflamed.

Who gets this disease?

Ankylosing spondylitis is not caused by an accident or injury. It is still not known how the disease occurs. Heredity seems to play an important role. Infections of the intestines or urinary tract also appear to play a role in the development of this disease. The body’s natural defenses against these types of infections suddenly turn against the body and cause inflammation in the vertebral joints.About one to two in a thousand people get this disease. This usually occurs between the ages of 15 and 35. It is rare that this disease only develops after the age of 35. Both men and women are equally affected by this disease. However, the disease is generally much more aggressive in men than in women.

Recognizing ankylosing spondylitis: signs and symptoms

The first complaints usually arise around the age of 25. It starts with complaints of stiffness in the lower back. These mainly occur at night and early in the morning. Sitting in the same position for a long time also worsens the complaints. The stiffness may be accompanied by complaints of pain. This often makes sleeping more difficult. Turning over in bed can also be painful. Over time, the complaints will spread via the lower back to the upper back.In most cases, other joints also become inflamed afterwards. This could be the hips, knees or shoulders. The fingers and toes can also become inflamed. In some cases the inflammations disappear again, sometimes they return later. Sometimes the inflammation does not disappear at all.Sometimes the eye also becomes inflamed: this occurs in one in three patients with ankylosing spondylitis. The eye is painful and red and the vision is blurred. Intestinal complaints may also occur with diarrhea and/or bloody discharge. A number of patients suffer from psoriasis: this is a skin condition in which the skin renews itself more quickly and becomes red and flaky.Fatigue is a common complaint of people with ankylosing spondylitis. This fatigue sometimes makes it difficult to carry out daily activities, studies or work. The fatigue can be so prevalent that it causes more complaints than the stiffness or pain.The vertebrae can eventually fuse together. This makes the back stiff, but the pain usually decreases. Organs such as the eyes, kidneys, heart, intestines, etc. can also become inflamed. Heart complaints occur in approximately five percent of patients. This usually concerns cardiac arrhythmias or a leaking heart valve. Ultimately, heart failure can develop.Breathing problems occur when joints between ribs and vertebrae become less mobile. This can cause a shortness of breath during activity. In most cases, however, one can breathe well using the diaphragm. Sometimes shortness of breath occurs because the chest is less mobile.Less strength in arms and legs or a tingling sensation occurs when vertebrae shift as a result of an inflamed intervertebral disc. This causes the spinal cord to become compressed and causes complaints in the arms and legs. A changing posture is characteristic of this disease. The back may be curved (bent forward) or sideways. This posture can sometimes be prevented by continuing to move and do exercises. In some cases it is possible to correct the posture through surgery.The diagnosis of ankylosing spondylitis is not so easy to make. There can sometimes be years between the first complaints and the final diagnosis. In some cases, the patient knows that he has this disease much earlier, before a doctor recognizes it. Often one looks in a completely different direction before one even thinks about ankylosing spondylitis. This means that many patients suffer from pain and stiffness for years before targeted treatment/pain relief can be started.

Cartilage turns into bone

In ankylosing spondylitis, cartilage turns into bone. A joint is protected by cartilage. Cartilage is a form of connective tissue with an elastic property. Cartilage can therefore withstand great pressure. Cartilage provides support and absorbs shocks.In ankylosing spondylitis, inflammation affects the cartilage. The damaged cartilage is replaced by bone by the body. Over time, the entire joint is formed from bone. Stiffness develops in the joint. But the joint also becomes much more brittle. This is called osteoporosis. This means that a bone fracture is much more likely to occur. Where cartilage has been replaced by bone, the inflammatory process has calmed down. The pain will be much less in these cases. The complaints will often first arise in the pelvis and the vertebrae.

Exercise is important

In addition to medication that reduces pain and the inflammatory process, exercise is a very important part of patients with ankylosing spondylitis. Most people stop exercising when the symptoms diminish or disappear, but then it is important to continue exercising during good periods.By exercising, the muscles are trained, fitness is maintained and the posture of the back remains as upright as possible. The exercises are often performed in the water, but this can also be done at home.Stretching exercises are an important part. The joint itself indicates its limit. Muscle strength must also be exercised well. This often makes it possible to continue moving despite the stiffness. Exercises are often also done to adapt to daily life: shopping, walking, cycling, doing chores around the house, etc. It isimportant not to force the exercises: listen to your own body. Perform the exercises in a relaxed manner and take rest between exercises. It is better to practice briefly three times a day than once a day for a long time. Very good sports for people with ankylosing spondylitis are: roller skating, swimming, cycling, walking and fitness. Exercise at least half an hour a day, five days a week.

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• Reiter’s disease