From the Guidelines
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing pain, stiffness, and potential fusion of vertebrae over time, as described in the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations 1.
Key Characteristics
- It belongs to a group of conditions called spondyloarthritis and typically begins in early adulthood, affecting men more frequently than women.
- The disease causes inflammation where ligaments and tendons attach to bones, leading to bone erosion and eventual new bone formation that can cause joints to fuse together.
- Common symptoms include lower back pain and stiffness that worsens with rest and improves with activity, fatigue, and limited spine flexibility.
Treatment and Management
- Treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for pain and inflammation, as recommended in the 2019 update 1.
- For more severe cases, biologics such as TNF inhibitors (adalimumab, etanercept, infliximab) or IL-17 inhibitors (secukinumab) may be prescribed.
- Regular physical therapy and exercise are crucial to maintain flexibility and posture, as emphasized in the 2016 recommendations 1.
Genetic Component and Triggering Factors
- The disease has a genetic component, with the HLA-B27 gene present in many patients, though environmental factors likely trigger the condition in genetically susceptible individuals.
- Early diagnosis and treatment are important to prevent spinal deformity and maintain quality of life, as highlighted in the 2016 recommendations 1 and the 2019 update 1.
From the Research
Definition and Overview of Ankylosis Spondylitis
- Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain 2.
- In more advanced cases, it can cause spine fusion 2.
- AS is a common type of spondyloarthropathy, characterized by lower back pain, enthesitis, and asymmetrical peripheral arthritis 3.
Pathogenesis and Etiology
- The pathogenesis of AS remains unclear, but immune cells and innate cytokines, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis, have been suggested to be crucial 2.
- Genome-wide association studies and cytokine pathways have been reviewed to understand the etiology and pathogenesis of AS 2.
Treatment and Management
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are recommended as a first-line drug treatment for AS 4, 3.
- TNF-alpha inhibitors, such as adalimumab, etanercept, golimumab, and infliximab, have been shown to improve clinical symptoms in the treatment of AS 5.
- Interleukin (IL) inhibitors, Janus kinase (JAK) inhibitors, and TNF-α inhibitors have been compared in terms of efficacy and safety in patients with AS 6.
- The choice of treatment depends on the severity of the disease, the presence of comorbidities, and the patient's response to previous treatments 4, 5, 3, 6.
Symptoms and Diagnosis
- AS is characterized by severe, chronic pain, enthesitis, and asymmetrical peripheral arthritis 2, 3.
- The disease can cause spine fusion in advanced cases 2.
- Diagnosis is based on clinical symptoms, imaging studies, and laboratory tests 2.
Treatment Outcomes and Safety
- NSAIDs have been shown to be effective in reducing pain severity and improving functional outcomes in patients with AS 4, 3.
- TNF-alpha inhibitors have been shown to improve clinical symptoms and reduce the risk of spine fusion 5.
- IL inhibitors, JAK inhibitors, and TNF-α inhibitors have been compared in terms of efficacy and safety, with TNF-α inhibitors being significantly superior to both IL and JAK inhibitors 6.