Causes Of Ankylosing Spondylitis
Researchers do not know the cause of ankylosing spondylitis. However, studies show that both genes and environment may lead to the development of the disease. Researchers know that the HLA-B27 gene increases the risk of developing ankylosing spondylitis, but this does not mean you will get the disease if you have the gene. Many people have the gene and never develop ankylosing spondylitis, which tells researchers that environmental factors also play a role.
Researchers continue to discover many other gene variations that may cause the disease however, HLA-B27 is the primary gene that increases your risk for developing ankylosing spondylitis.
Eli Lilly’s Taltz Approved For Ankylosing Spondylitis
In August 2019 the FDA approved Eli Lillys Taltz injection for the treatment of adults with active ankylosing spondylitis .
Like Cosentyx, Taltz is also classified as a humanized interleukin-17A antagonist. Taltz works to lower pain and swelling by inhibiting the release of pro-inflammatory cytokines and chemokines. It’s also approved for the treatment of plaque psoriasis and psoriatic arthritis.
FDA approval was based on Phase 3 studies in 657 adults. At 16 weeks, patients achieved ASAS40 at the following significant response rates:
- COAST-V study : 48% of patients treated with Taltz every 4 weeks versus 18% of patients treated with placebo.
- COAST-W study : 25% of patients treated with Taltz every 4 weeks versus 13% of patients treated with placebo.
The safety profile observed in patients with AS treated with Taltz was consistent with the safety profile in patients with psoriasis. The most common side effects of Taltz include:
- Injection site reactions
- Fungal infections
Key Points About Ankylosing Spondylitis
- Ankylosing spondylitis is a type of arthritis that causes inflammation in certain parts of the spine.
- A gene may be part of the cause of AS. But an exact cause is unknown.
- Symptoms of AS include back pain, early morning stiffness, and a stooped posture.
- AS can cause other symptoms such as appetite loss, weight loss, fatigue, fever, anemia, eye inflammation, and digestive illness.
- The goal of treatment for AS is to ease pain and stiffness, prevent deformities, and maintain as normal a lifestyle as possible.
- Staying active is important in the management of AS.
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What Is The Most Important Information I Should Know About Humira
You should discuss the potential benefits and risks of HUMIRA with your doctor. HUMIRA is a TNF blocker medicine that can lower the ability of your immune system to fight infections. You should not start taking HUMIRA if you have any kind of infection unless your doctor says it is okay.
- Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. Your doctor should test you for TB before starting HUMIRA, and check you closely for signs and symptoms of TB during treatment with HUMIRA, even if your TB test was negative. If your doctor feels you are at risk, you may be treated with medicine for TB.
- Cancer. For children and adults taking TNF blockers, including HUMIRA, the chance of getting lymphoma or other cancers may increase. There have been cases of unusual cancers in children, teenagers, and young adults using TNF blockers. Some people have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. If using TNF blockers including HUMIRA, your chance of getting two types of skin cancer may increase. These types are generally not life-threatening if treated tell your doctor if you have a bump or open sore that doesnt heal.
Cosentyx: Expanding Treatment Options For Ankylosing Spondylitis
Cosentyx is the brand name for the drug secukinumab and is administered by subcutaneous injection, usually every four weeks.
Secukinumab inhibits interleukin-17A , effectively blocking the release of chemicals by the immune system responsible for inflammation.
Fever, headache, muscle aches, sore throat, fatigue and a stuffy or runny nose are common side effects. Cosentyx also increases your risk of infection and patients treated with Cosentyx should not receive live vaccines.
Studies have shown that 61% of patients had an improvement of at least 20% in their ankylosing spondylitis symptoms after 16 weeks of Cosentyx treatment, with 36% experiencing over 40% improvement. Many of these patients had failed to respond to, or were intolerant of, biologics.
In June 2020, the FDA also approved Cosentyx to treat active non-radiographic axial spondyloarthritis . nr-axSpA is part of the axSpA spectrum, which is characterized by inflammatory arthritis of the spine associated with chronic inflammatory back pain, but may not show on X-ray studies.
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Stooped Neck And Shoulders
As ankylosing spondylitis progresses, more bones can be fused together, including those in the cervical spine.
We look down a lotlooking at our phones, computers, or even our dinner plates. But ankylosing spondylitis patients also lean forward because it helps to relieve other back pain, explains Johns Hopkins Medicine. This puts the spine in a flexed position, explains Nick Shamie, MD, chief of orthopedic spine surgery and professor of orthopedic surgery and neurosurgery at UCLA School of Medicine, and ankylosing spondylitis patients can end up with their bones fused in this position.
“If you look down at your feet right now and imagine your neck was locked in that position it would make life very difficult, not only for mobility but even eating, because…you can’t open your mouth as well,” Dr. Shamie tells Health.
Stooped posture that has frozen that way is one of the biggest reasons surgery might become necessary for ankylosing spondylitis patients, says Dr. Shamie.
What Is The Prognosis For People Who Have Ankylosing Spondylitis
Ankylosing spondylitis symptoms may gradually worsen as you age. The condition is rarely disabling or life-threatening. Still, symptoms like joint pain may interfere with your ability to do the things you love. Early interventions can ease inflammation and pain. A combination of physical activity and medications can help.
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Who Is At Risk
About 2.7 million American adults have AS or other type of spondylitis, according to the Spondylitis Association of America.
AS is most common in young men: The condition usually starts between ages 17 and 45. However, women and children can also get AS.
People who have the HLA-B27 gene and a family history of the disease are more likely to get AS. However, you dont need the gene to have AS, and some people who do have it never get the disease.
Myth Or Fact If Tnf Blockers Don’t Work There Aren’t Any Other Options
Wrong. This is a myth for sure. TNF blockers are effective for many patients with ankylosing spondylitis , but there are still other options for patients who do not respond or cannot use or tolerate them.
- In 2016, the FDA approved Cosentyx for AS, offering a totally new type of treatment option.
- In August 2019, the FDA also okayed Eli Lillys Taltz injection for the treatment of adults with active ankylosing spondylitis .
- In December 2021, the FDA approved Xeljanz and Xeljanz XR to treat adults with ankylosing spondylitis when at least one TNF blocker medicine has been used and did not work well or cannot be tolerated.
Local injections of corticosteroids, such as methylprednisolone , can be used intermittently if there is evidence of local joint swelling. Long-term, chronic use of oral corticosteroids is discouraged due to serious side effects.
Sulfasalazine, an oral disease-modifying drug often used in rheumatoid arthritis, may be used in AS patients with symptoms in other areas besides just the spine. In general, opioid pain medications should be avoided due to side effects and concern for addiction.
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Endocrine And Metabolic Disease
Porphyrias
Porphyrias are inherited or acquired disorders of heme biosynthesis and can be erythropoietic, hepatic, or mixed in nature, each associated with a specific enzyme defect in the heme pathway. Porphyria cutanea tarda, the most common porphyria, is a hepatic porphyria with acquired and sporadic forms . It is caused by a deficiency in uroporphyrinogen decarboxylase, leading to the accumulation of uroporphyrin in the urine and serum.
Precipitating factors include alcohol ingestion, estrogen administration, certain hepatotoxins , HIV infection, hemochromatosis, and hepatitis C infection. Manifestations of porphyria cutanea tarda include photosensitivity, skin fragility, bullae and erosions on sun-exposed skin , and hypertrichosis. Biopsy reveals a subepidermal bulla with festooning of the dermal papilla. Direct immunofluorescence reveals IgG and C3 at the dermal-epidermal junction and in vessel walls.
Differential diagnosis includes bullous SLE, epidermolysis bullosa acquisita, pseudoporphyria, and variegate porphyria.
Treatment includes phlebotomy and antimalarial drugs.
Pseudoporphyria
Pseudoporphyria mimics porphyria cutanea tarda without an enzyme defect plasma and urinary porphyrins are normal. Medications are the most common cause of pseudoporphyria. Less common causes are tanning bed use and hemodialysis.
Differential diagnosis is the same as for porphyria cutanea tarda.
Treatment includes removal of the cause.
What Are The Symptoms Of Ankylosing Spondylitis
Symptoms of AS tend to come and go over time. Symptoms can occur a bit differently in each person. The symptoms may include:
- Back pain, usually most severe at night during rest
- Early morning stiffness
- Organ damage, such as to the heart, lungs, and eyes
- Digestive illness
Many of these symptoms may be caused by other health problems. Make sure to see your healthcare provider for a diagnosis.
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How Is Ankylosing Spondylitis Treated
Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. The goal of treatment is to ease pain and stiffness, prevent deformities, and maintain as normal a lifestyle as possible. Treatment may include:
- Nonsteroidal anti-inflammatory drugs , to ease pain and inflammation
- Tumor-necrosis-factor blockers , to ease inflammation and swelling
- Interleukin-17A inhibitors, to ease inflammation and swelling
- Disease-modifying anti-rheumatic medicines , such as sulfasalazine, to ease inflammation and control AS
- Short-term use of corticosteroids, to ease inflammation
- Short-term use of muscle relaxants and pain relievers, to ease severe pain and muscle spasms
- Surgery to replace a joint, place rods in the spine, or remove parts of the thickened and hardened bone
- Maintaining of proper posture
- Regular exercise, including exercises that strengthen back muscles
Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.
Osteoporosis And Spinal Fractures
Osteoporosis is where the bones become weak and brittle. In AS osteoporosis can develop in the spine and increase your risk of fracturing the bones in your backbone. The longer you have the condition, the more this risk increases.
If you do develop osteoporosis, you’ll usually need to take medicine to help strengthen your bones.
There are a number of medicines that can be used to treat osteoporosis, which can be taken by mouth as tablets or given by injection.
Read about treating osteoporosis.
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What Psoriatic Arthritis Looks Like
PsA is characterized by the symptoms it causes. This includes swelling and stiffness of joints, low back pain, foot pain, eye symptoms, skin changes, and nail symptoms. It is important to recognize the signs and symptoms so your doctor can properly diagnose you and start treatment as early as possible.
Lay Down Knees Bent Breathe
Lying on your back, knees bent, feet flat on the ground:
Put your hands on your ribs at the sides of your chest. Breathe in deeply through your nose and out through your mouth, pushing your ribs out against your hands as you breathe in. Repeat about 10 times. Remember, its as important to breathe out fully as it is to breathe in deeply.
Put your hands on the upper part of the front of your chest. Breathe in deeply through your nose and then breathe out as far as you can through your mouth. Push your ribs up against your hands as you breathe in again about 10 times. You can do this exercise at any time in a lying or sitting position.
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Myth Or Fact Ankylosing Spondylitis Leads To Severe Disability
Myth. Not everyone with ankylosing spondylitis has severe disease or physical disability – the disease course is variable and differs greatly among patients.
It is not a life-threatening disease and many people are able to work and function normally throughout their day. In most cases, AS is characterized by painful episodes followed by remissions, a time where the pain subsides.
Studies have shown that patients who have disease onset at an older age may be more prone to severe joint damage. In addition, smokers were more than four times as likely to have severe damage as nonsmokers.
For severe ankylosing spondylitis or other joint problems, surgery or joint replacement may rarely be required.
Myth Or Fact Tnf Blockers Can’t Help Slow Damage In As
Whether TNF blockers can slow disease progression in AS has been a controversial question, mainly because longer-term studies are needed.
A study by Haroon and colleagues found that TNF blockers can reduce progression of spinal damage as seen on an X-ray by up to 50%. Researchers state that treatment needs to be started early and continued long-term.
- In the study, a benefit was seen at 4 years. Compared to patients who started treatment earlier, those who waited 10 or more years to begin TNF blockers were twice as likely to progress.
- In this study, NSAID use did not have a significant effect on progression but patients may still need to use NSAIDs for ‘rescue’ pain control.
A large structured review of 23 studies, published in 2020, suggests that TNF inhibitors were able to slow down radiographic progression of disease in the spine.
- Patients were assessed using the modified Stoke Ankylosing Spondylitis Spine Score . Researchers found that mSASSS progression in patients with AS was generally minimal and slow with long-term TNF blocker therapy.
- Also, several studies suggest patients were more likely to progress in their disease when not using a TNF inhibitor.
- The rate of progression following continuous secukinumab , an interleukin inhibitor treatment, was low and remained stable over 4years.
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Sex Pregnancy And Ankylosing Spondylitis
Sex may be painful if you have ankylosing spondylitis. If it is, try taking some painkillers beforehand and experiment with different positions.
Ankylosing spondylitis can make you feel tired, so its important your partner understands how your condition affects you. Good communication can help you maintain an active sex life and counselling can sometimes benefit both partners.
Its fine to use the contraceptive pill if you have ankylosing spondylitis, but you should tell your doctor youre taking it.
If youre thinking of starting a family, its very important for both men and women with ankylosing spondylitis to discuss medication with a doctor beforehand.
Some drugs such as methotrexate should be stopped several months before a woman tries to get pregnant. Latest research suggests its safe for men to take methotrexate when trying for a baby with their partner.
Biological therapies seem to be safe in the earlier stages of pregnancy but are then stopped later in pregnancy.
If you become pregnant while using a conventional DMARD such as methotrexate or a biological therapy, discuss this with your rheumatology team as soon as possible.
Usually, pregnancy doesnt cause any special problems for the mother or baby, though the symptoms of ankylosing spondylitis may not ease during pregnancy. If your spine is very stiff, it may not be possible to have an epidural during childbirth. This is an injection into the back that stops people feeling pain in part of the body.
Symptoms Of Ankylosing Spondylitis
The most common symptom of ankylosing spondylitis is lower back and/or hip pain and stiffness. Over time, the symptoms may progress to other areas of the spine. The pain typically worsens during periods of rest or inactivity, which may cause some people to experience more pain during the middle of the night or after prolonged sitting. Usually, moving and exercise can help improve pain.
Symptoms of ankylosing spondylitis vary from person to person. Some people have mild episodes of pain that come and go, while others will have chronic, severe pain. The symptoms of ankylosing spondylitis, whether mild or severe, may worsen in flares and improve during periods of remission.
Because the disease can affect other areas of the body, other symptoms may develop and may include:
- Pain, stiffness, and inflammation in other joints, such as the ribs, shoulders, knees, or feet.
- Difficulty taking deep breaths if the joints connecting the ribs are affected.
- Vision changes and eye pain due to uveitis, which is inflammation of the eye.
- Fatigue, or feeling very tired.
- Loss of appetite and weight loss.
- Abdominal pain and loose bowel movements.
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Ankylosing Spondylitis A Type Of Axial Spondyloarthritis Can Be Tricky To Diagnose These Other Diseases Can Present Similarly To As And Cause A Misdiagnosis
When Kristin Cornelius was hooking up the washer and dryer in her new house, she noticed an insanely bad pain in her thumb. I figured I had stubbed it on a box or something, she shared in a personal story. But the pain in her thumb joint only got worse, and over the next few days, she felt similar symptoms in her finger joints, ankle joints, and Achilles tendon.
At 37 years old, Cornelius had been combatting back pain for years. She had been taking fistfuls of NSAIDs, which she recently stopped because of stomach issues. But this pain was different. She went back to her doctor, who sent her to someone else to have her stomach checked make sure her joint pain wasnt connected to Crohns disease. It wasnt.
The rheumatologist was up next, she wrote. For three months leading up to the appointment, she endured flares and inflammation in at least one joint but often multiple joints every single day. She journaled all of it for the doctor to review.
Then he asked the one question no one had ever asked me before: Does your back pain feel worse in the morning when you first wake up than after youve been up and moving for a while?