A physio’s perspective: Ankylosing spondylitis

April 20, 2023 by Lisa Bywaters

In recognition of World Ankylosing Spondylitis Day on Saturday 6 May, Andrew Zhang, a rheumatology physiotherapist, has written this blog.

My name’s Andrew, and I work at a large tertiary hospital in Sydney. I have the privilege of working with some amazing rheumatologists in the management of people living with ankylosing spondylitis (AS).

Ankylosing spondylitis is an uncommon disease that isn’t well recognised. Even some health professionals struggle to identify it early on. It’s frequently mistaken as common back pain, with the average time to be accurately diagnosed for many people being around 5-9 years!

AS is an autoimmune inflammatory arthritis. That means the body attacks its own joints, tendons and ligaments, mainly in the spine, resulting in pain and stiffness. Over time, this inflammation can lead to fusion (ankylosis) of the spine and ribcage. If AS is not well managed, it can result in permanent changes to the spine and a hunched posture. The back is also susceptible to fractures, and breathing may be more difficult due to restricted movements.

We don’t know why, but it’s speculated that genetic and environmental factors are involved in developing the disease, including a strong family history and correlation with the HLA-B27 gene – but not with everyone. It’s quite common for people to notice symptoms from early adulthood.

People with ankylosing spondylitis commonly experience acute flares of back or buttock pain and tend to feel stiff in the mornings when they wake. They may also feel pain in areas other than the spine – commonly the back of the heel, underneath the foot, chest wall and eyes.

In addition, people with AS may also experience high levels of fatigue and other inflammatory conditions such as uveitis, inflammatory bowel disease and psoriasis.

Early recognition and referral to a rheumatologist, specialist doctors who diagnose and manage musculoskeletal conditions and autoimmune diseases, is crucial for this progressive disease.

Diagnosis is based on a thorough history and physical examination, as well as blood tests and imaging which are usually requested to look for evidence of active inflammation. Nonetheless, someone can still have ankylosing spondylitis with these results being completely normal!

Rheumatologists treat ankylosing spondylitis patients with medications that reduce inflammation. This can include non-steroidal anti-inflammatory drugs and/or biological disease-modifying anti-rheumatic drugs (biologics). Biologics dampen the immune system to reduce disease activity; however, this immunosuppression may increase the risk of infections and illnesses.

Physiotherapy is also important to help manage AS. The aim is to reduce pain, stiffness, and joint damage and increase physical function and quality of life. This should always involve a personalised exercise program consisting of movements and stretches to maintain flexibility and strength, as well as aerobic exercises to improve cardiovascular fitness and chest expansion. Hydrotherapy (exercise in warm water) also has a positive effect. Physiotherapists should also be great health educators highlighting the importance of regular exercise, back care and posture, and a healthy and active lifestyle!

Many patients I see with ankylosing spondylitis have bounced between many health professionals before their eventual diagnosis; which for them can both be a relief and overwhelming. That’s why working closely with my patients as a health educator and treating the whole person is essential. It’s also very rewarding work.

With the advancements in modern medicine, most people living with ankylosing spondylitis can go about their usual activities without limitations if it’s diagnosed early and well-managed with medication and physiotherapy.

So join me and help spread the word about AS on World Ankylosing Spondylitis Day!

Andrew Zhang

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