What is ankylosing spondylitis?
Ankylosing spondylitis can affect anyone but is more common in young men. It usually starts in the late teens or early 20s. It should be considered when there is new onset back pain below the age of 40.
The back pain can be anywhere in the spine, but commonly it occurs in the sacroiliac joints. It tends to affect the base, or the bottom part of the spine.
The characteristics of inflammatory back pain are that it causes morning stiffness. It tends to wake you in the second half of the night and there is sometimes a family history of spondylitis.
By diagnosing the condition early, we can prevent damage and often put you on a very effective treatment, which will significantly improve your pain and allow resolution. Early diagnosis is therefore extremely important.
People who see me complain of new onset back pain, neck pain, fatigue, waking in the second half of the night; they sometimes have associated large joint arthritis and they may have other conditions, such as psoriasis or inflammatory bowel disease.
About 30% of people with psoriasis will develop inflammation in their joints at some point in their life. Inflammatory spinal pain can incur as a result of several conditions, one of them being ankylosing spondylitis, but psoriasis and inflammatory bowel disease can also lead to inflammation in the spine.
When patients visit the clinic with ankylosing spondylitis, we take a history and perform a thorough physical examination. We sometimes test for a particular gene, called HLA B27. This is a risk factor for the development of the condition and can be associated with disease severity in men.
During your first appointment, you would have a clinical examination, blood tests, some X-Rays and possibly some imaging with MRI.
At our first appointment, we might start you on treatment and refer you for physiotherapy. You’d then return to see us for the results of those tests in around two weeks, to assess whether you’ve responded to the treatment you’ve been given. If not, we’ll then decide a more longer-term treatment plan for you.
The treatment is always tailored to you and your wants and needs.
We would follow up with you until you’re in remission, making sure the inflammation and pain is controlled. We’d usually see you at baseline, so we’d take some measurements and tests, and see you again in three months’ time if you’re feeling better.
We’ll then see you again in six months, and then again at 12 months.