The main feature of AS is the presence of radiographic sacroiliitis, that is, the presence of structural alterations of the sacroiliac joints (between the sacrum and the iliac bones) identifiable on the pelvic X-ray. Over time, sacroiliitis lesions can progress to a total fusion of the joint. On the other hand, the disease can also affect other segments of the spine (namely the cervical and lumbar spine). This occurs due to calcifications that form between the vertebra (syndesmophytes) which can later evolve into a more severe stage, with calcification of the anterior and posterior longitudinal ligaments (“bamboo” column). This damage tends to accumulate with the evolution of the disease and with the patient’s complaints of increased pain. It also leads to a significant decrease in the mobility of these patients.

The causes of AS are unknown; however, smoking is recognized as a risk factor. We also know that there is a genetic predisposition, with the diagnosis being more frequent among family members. The gene responsible for most of this predisposition is HLA-B27.

This disease affects mainly young individuals. It is quite rare, but not impossible for symptoms and diagnosis to begin on individuals after the age of 45 years. We should therefore be especially aware when patients age 20 to 40 years begin complaining of chronic low back pain.

Its main manifestation is chronic low back pain (lasting for periods longer than 3 months) with an inflammatory rhythm. By this we mean that low back pain is present in the morning, even before there is any physical effort, and that can wake up the patient during the night, not improving with rest and, surprisingly, able to improve with movement. The prolonged morning stiffness is also common. The association with other peripheral signs and symptoms such as arthritis, enthesitis (inflammation of tendons) and dactylitis (generalized inflammation involving the joints, tendons and connective tissue of a particular finger) is also characteristic. Even in the very early stages of the disease, patients present quite significant levels of fatigue, loss of functional capacity for their daily activities and work impairment. In more advanced cases, loss of mobility of the spine and the affected joints is also an important component of loss of quality of life.

In addition to the articular and extra-articular manifestations mentioned above, these patients also have a set of associated comorbidities, as osteoporosis and gastroduodenal ulcer.

The treatment of these patients must be an individualized treatment plan based on two main pillars: pharmacological and non-pharmacological treatment. The first essentially consists on the use of anti-inflammatory drugs that are fortunately effective for most patients or biotechnological drugs (if needed). This option opens new horizons for population suffering from this pathology, as it has the ability to significantly change the course of the disease, greatly improving the quality of life of these patients.

Non-pharmacological treatment should be transversal to all patients: recommendation for healthy lifestyle habits, namely smoking cessation, balanced diet and regular exercise are extremely important.

For more information contact Grupo HPA Saude on +351 282 420 400