- A confirmation diagnosis from the doctor along with objective evidence of the disease by X-rays and laboratory testing. Fixation of the dorsolumbar or cervical spine at 45° in the X-ray points to debilitating AS. Fixation of the cervical spine or dorsolumbar spine at 30° or more of flexion but less than 45° when measured from the vertical position may also be considered.
- There must be involvement of at least two body systems with a moderate amount of severity.
- A patient may also claim benefits under them, another section from under 14.09, Inflammatory Arthritis, provided the doctor documents in the medical records that the patient has severe symptoms such as severe pain, stiffness, and decreased range of motion in the spine that prevent them from working by restricting their functional capacity to sit, stand, walk, lift, or carry.
- It is important that a doctor also documents the effects the symptoms have on the patient’s ability to work by documenting the most weight the patient can lift/carry in an 8-hour workday and how long they can walk/stand or sit.
What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine and causes inflammatory back pain. It also affects the joints in the shoulders, hips, ribs, heels, and other joints. It is a systemic disease, which means that it is not just limited to the bones and joints. AS causes swelling of the spinal joints (vertebrae) leading to severe and chronic pain, stiffness, and discomfort. In this condition, formation of the new bone tissue in the spine causes sections of the spine to fuse in a fixed and immobile position. The spine becomes less flexible over time and results in a hunched forward posture. If left untreated, the inflammation may result in impaired mobility to an extent that the patient may be bedridden or even wheelchair bound. Warning signs of AS are as follows:
- There is persistent and excruciating pain in the lower back, heel(s), joints, or chest, especially after waking up in the morning, for more than 90 days.
- Pain may come and go, but it’s gradually moving up the spine and it’s getting worse.
- The patient may get relief from the symptoms only by taking nonsteroidal anti-inflammatory drugs (NSAIDs)/painkillers.
- Early signs and symptoms of AS include pain and stiffness, particularly in the lower back and sacroiliac joint (hips), especially during early mornings or after long periods of inactivity. Stiffness, inflammation, and pain can be seen in other joints of the body. The shoulders, neck, hips, ribs, heels, and small joints of the hands and feet may be involved.
- Systemic features such as weight loss, fever, fatigue, and inflammation are common.
- Enthesitis (inflammation of the ligaments, tendons, and capsules attached to the bone, mainly in the spine, sometimes Achilles tendon [in the back of the heel], and the cartilage between the breastbone and ribs) is a common symptom.
Causes and risk factors:
- There are no specific known causes for AS; however, genetic factors seem to be involved in over 90% of the people with AS (gene HLA-B27).
- AS is more common in male gender.
Depending on the signs and symptoms and medical condition of the patient, AS may be managed conservatively or surgically.
- Symptomatic management with medication: NSAIDs/painkillers give relief from inflammation, pain, and stiffness.
- Surgery: It is usually not required in most AS cases; however, the doctor might suggest this option when the patient is in a progressed stage where the pain is severe. The doctor may repair or replace the damaged joints (hip/knee) and tendons.
- Physical therapy: This has proven to be the most effective in patients with AS. Exercises are designed to improve the flexibility and range of motion. Doctors recommend stretching and strength-building exercises for improving posture and strength. Proper sleep and walking positions and abdominal and back strengthening exercises are designed to improve or avoid the hunched forward posture and maintain upright position in patients. Doctors recommend deep breathing exercises as well. They recommend swimming as a choice of exercise because it has shown a good result in patients with AS. It helps reduce pain and improve the posture and breathing.
The course of the disease is hard to predict. The signs and symptoms of AS may relapse and quiet down. Most people can function well unless they have a lot of damage to the hips or the spine.