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Ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the sacroiliac joints and axial skeleton, leading to back pain, stiffness, and progressive spinal ankylosis. It commonly begins in young adults and is strongly associated with HLA-B27. Patients typically have inflammatory back pain that improves with exercise, and advanced disease may produce a rigid kyphotic spine and characteristic radiographic changes such as sacroiliitis and a bamboo spine.

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy that predominantly involves the sacroiliac joints, spine, and entheses. It usually begins in adolescence or early adulthood and is more common in males. The disease has a strong association with HLA-B27, although the presence of HLA-B27 alone is not diagnostic. The typical presentation is inflammatory low-back pain and stiffness, often worse in the morning or after rest and improving with physical activity. Patients may also develop reduced spinal mobility, limitation of chest expansion, buttock pain due to sacroiliitis, and peripheral joint or entheseal involvement. Extra-articular manifestations can include acute anterior uveitis, inflammatory bowel disease, psoriasis, and cardiovascular or pulmonary complications. Diagnosis is based on clinical features together with imaging and laboratory findings. Plain radiographs may show bilateral sacroiliitis, vertebral squaring, syndesmophyte formation, and ultimately the classical bamboo spine appearance. MRI is particularly useful for detecting early active sacroiliitis before radiographic changes become established. Inflammatory markers such as ESR and CRP may be elevated. Management focuses on maintaining spinal mobility, controlling inflammation, and preventing deformity. Regular exercise and physiotherapy are fundamental, while NSAIDs are commonly used for symptom control. Patients with persistent active disease may require biologic or targeted therapies such as TNF inhibitors or IL-17 inhibitors under rheumatological supervision. Advanced disease may lead to a rigid, osteoporotic spine with increased susceptibility to unstable spinal fractures and neurological injury, even after relatively minor trauma. Severe hip involvement, fixed deformity, or neurological complications may occasionally require orthopaedic surgical intervention.

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