Understanding Ankylosing Spondylitis

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March 18, 2023
Edward Smith

What is Ankylosing Spondylitis? 

Ankylosing Spondylitis, or AS, is an auto-immune disease. This category of disease is caused when a person’s immune system is hyperactive and malfunctions, attacking the body’s own tissues instead of protecting them and causing chronic inflammation. Ankylosing Spondylitis is characterized by the tissues the immune system attacks, namely all parts of the spine, sacroiliac joints, ribs, sternum, and periphery joints. Although this disease can attack any organ or joint in the body, most patients are diagnosed because of back and hip pain and stiffness. Over time the inflammation causes joint deformities, disability, and chronic pain.

What Causes Ankylosing Spondylitis?

AS has a hereditary component, meaning it tends to run in families. More than 80% of diagnosed AS patients possess a genetic marker associated with the disease, a gene called HLA-B27. Many rheumatologists include testing for this gene as part of the diagnostic work-up for diagnosing AS. However, not all people with the HLA-B27 gene develop AS, and a significant portion of people with AS do not possess the genetic marker. This is suspected because AS can also be triggered by environmental causes, such as recurrent infections or chronic illnesses, exposure to environmental toxins, and even traumatic experiences.

Why Treat Ankylosing Spondylitis?

Treatment for AS is critical to preserving the quality of life and ability to function. Without treatment, AS advances to a stage where the chronic inflammation causes abnormal bone growth, especially in the spine and rib cage. Over time, joints in the spine grow so much abnormal bone that they fuse together. This can create a condition called a bamboo spine, in which the spine connects like a piece of bamboo. Ribs can also link together, compressing nerves and causing severe pain. The spinal canal, a hollow space through which the spinal nerve cord passes, can grow narrower, causing spinal stenosis. The earlier the diagnosis and the more aggressive the treatment determine patient outcomes.

Treatment for Ankylosing Spondylitis

First-level treatments for AS include NSAIDs, or non-steroidal anti-inflammatory drugs, related to ibuprofen and naproxen sodium. These work by reducing inflammation but are not ideal for everyday use. The next level of treatment is corticosteroids, such as prednisone. Although incredibly effective against inflammation, prednisone has serious risks that make it unsafe for anything but episodic use.

Disease Modifying Anti-Rheumatic Drugs

The next level of medications used to treat AS are DMARDs, or disease-modifying anti-rheumatic drugs. These drugs work by making changes in the body over time to affect the ability of the disease to cause inflammation. The most used DMARD for AS is methotrexate. Originally used to treat leukemia, methotrexate is a chemotherapy drug. When leukemia patients with AS were treated with methotrexate, doctors found that their symptoms improved significantly. Fortunately, the amount of methotrexate needed to regulate AS is a tiny fraction of the dose necessary for cancer treatment. Although patients may still experience some nausea and minimal hair shedding, the side effects are nothing like those experienced with full chemotherapy treatment.

Methotrexate can be taken in pill form or via injection. Although many patients opt to start with the pill form, this is not advisable. Methotrexate as an injection has so many advantages over the pill form that doctors should completely cease prescribing it in pill form. As an injection, methotrexate completely bypasses the digestive tract but eliminates the worst side effects of this medication. Patients can expect nausea, vomiting, digestive upset, and possibly diarrhea if using the pill form. Patients who begin methotrexate in pill form almost always switch to the injection. It is in the patient’s best interest to accept that they will be giving themselves a weekly injection for the rest of their lives and not bother with methotrexate in pill form, especially given that the injection itself is easy and virtually painless. In contrast, the pills are well-known to be poorly tolerated and unpleasant.

Unfortunately, since methotrexate decreases inflammation by suppressing part of the immune system, patients on this medication are at an increased risk of developing opportunistic infections, including viral, bacterial, and fungal infections. Another DMARD seeing more use recently, which does not cause as much immune suppression as methotrexate, is hydroxychloroquine. This medication can reduce inflammation without some of the side effects of methotrexate. However, it takes weeks to months to become effective in the body.

Biologic Medications

The next group of medications used to treat AS are biologics. These monoclonal antibody treatments use lab-grown human antibodies to interrupt a part of the inflammatory reaction within the patient’s body. Most of these medications are given via injection, which the patient performs at home. These medications include Enbrel, Humira, Cimzia, Simponi, Amjevita, Taltz, and Cosentyx. Remicade and Inflectra are given as intravenous infusions and must be administered by a nurse at an infusion center. Xeljanz is currently the only biologic that comes in pill form. These medications carry the same immune-suppressive side effects as methotrexate. However, doctors generally agree that the rewards outweigh any risks of these medications, especially considering how debilitating and excruciating untreated AS can be.

Ankylosing Spondylitis and Injuries 

AS attacks the spine and spinal tissues, making patients more susceptible to injury. For example, those with spinal fusions are much more likely to experience spine fractures in auto collisions and falls. AS patients are also at a greater risk of disc injuries, spinal cord injuries, and nerve impingements. Because the disease spurs an exaggerated inflammatory response, injuries can take longer to heal, requiring more time away from work. For these reasons, it is critical that anyone with AS who is injured contact a reputable California personal injury lawyer as soon as possible. Often those with As will need additional treatment to return to function, and an injury lawyer will ensure the patient receives all medical treatment necessary to return to everyday life.

The YouTube video below describes the symptoms, causes, and diagnosis of Ankylosing Spondylitis.

Northern California Personal Injury Lawyer

I’m Ed Smith, a Northern California Personal Injury Attorney. If you have been injured in a car accident and developed Ankylosing Spondylitis as a result, please call our experienced legal team at (916) 921-6400 or (800) 404-5400 for free, friendly case advice.

See our proven track record of successful Verdicts and Settlements.