The rugby player John Hayes talks about Ankylosing Spondylitis in a current radio campaign. This inflammatory disease is one of the family of rheumatic inflammatory diseases that do best when diagnosed early and managed well.
There are approximately 44,000 Irish people affected by this disease, which mainly comes on between the ages of 18 to 44 and is far more common in men than women. Most commonly the inflammatory process burns itself out in mid life.
Ankylosing Spondylitis, often known by its abbreviation AS or Anky Spon, is an auto-immune disorder, where body tissues start to attack themselves. It involves chronic ongoing inflammation of the joints all along the spine and can spread to joints of the pelvis and shoulders.
Rheumatic diseases such as Rheumatoid Arthritis, Psoriatic Arthritis and AS all attack both joint surfaces and other body tissues.
In the case of AS, problems can develop in the eyes, heart, lungs and kidney systems, which is why this family of diseases are called systemic diseases. In contrast Osteoarthritis or wear and tear degeneration may affect one or two joints but does not involve the whole body.
AS usually presents first as back or spinal pain. Back pain is quite common in this18-44 age group, but the presentation of AS is generally clinically different from regular or non-specific back pain.
The first difference is that in young adulthood, the onset of standard back pain often relates to a specific incident: a tumble at sports or a heavy manual task around the house or at work. Mechanical back pain naturally progresses towards recovery, so even without treatment, symptoms will eventually get better.
Back pain in AS starts gradually and either remains low grade for extended periods of time or becomes more and more debilitating as times goes on, instead of gradually getting better unaided as would usually be the case. In AS, the person is often unable to identify any specific activity that first started the pain.
Unlike straightforward back pain, AS back pain is strongly associated with stiffness in the mornings, so the young sufferer may behave like a much older person on rising. Dressing and preparing to leave the house in the morning can be challenging. Symptoms do improve somewhat during the day, though prolonged static positions such as sitting at a desk without interruption will bring stiffness to the fore again.
In the work environment, prolonged standing or sitting, or a job involving lifting and carrying can re-inflame symptoms during the day, whereas a job involving moving around presents less difficulty.
A clinical diagnosis of AS is confirmed by specific blood tests and on simple x-rays. Both give clear evidence of the disease. Treatment is then led by a Consultant Rheumatologist with the GP, Chartered Physiotherapist, Occupational Therapist and others as part of the ongoing management team.
Two main strands of intervention are drug therapy and physical rehabilitation. Medical management concerns effective drug prescription. This is a complex area where new developments come on stream all the time and so are only prescribed by Consultants.
AS patients need to take medication until the disease burns itself out in mid life. At this stage, AS stops being an active disease and patients may have reduced pain but have to deal with very stiff joints.
The primary goal of the drugs is not just pain relief, but to modify the immune response in the body so that the disease does as little destructive damage as possible.
Rehabilitation is the second ongoing treatment for AS. Exercise is vital to maintain as much mobility in the spine, pelvis, shoulders and ribcage. However, each individual AS sufferer needs a tailored exercise plan. Too much or the wrong exercise is detrimental, as is none or too little exercise.
This is where Chartered Physiotherapists come in, with their specialist knowledge to monitor effects of each component of exercise, alter it as necessary and ensure that exercise brings best possible benefit to the individual.
Some young men in this age group are sports fanatics. Perhaps surprisingly, the body’s response to sport can give vital clues as to the presence of something more serious than non-specific back pain, as inappropriate exercise will bring on worsening symptoms.
Contact sports should be avoided as the stiffer skeleton of an AS patients is unable to withstand physical knocks. Heavy weight regimes are also problematic. Treadmills or rowing machines, or using jogging as a fitness tool are not advised.
Almost without exception swimming is the one exercise that all AS patients find beneficial, often saying that the only time they feel mobile and painfree is in the pool. Hydrotherapy can be great in this case and under professional supervision, can provide a really appropriate water based programme that can then be carried on in a local pool.
Ankylosing Spondylitis has the capacity to become very debilitating if undiagnosed. If left unchecked, the joints of the spine and pelvis become permanently fused, the ribcage loses flexibility and the capacity for normal spinal motion can be severely restricted.
In the past it was relatively common to see older men permanently bent double. Thankfully this is rare now as with correct medical intervention, much can be done to retain upright posture and modify the ravages of this rheumatic disease.
Copyright Mairead O’Riordan
Mairead O’Riordan is a Consultant Chartered Physiotherapist and CEO of TherapyXperts. She and her colleagues Danielle O Meara, Germaine Mallin and Genevieve Fay practice at TherapyXperts Maynooth. Tel: 0818 333 611 or
01-628 9341.
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