How ankylosing spondylitis presents
AS primarily affects young adults, with onset typically between ages 20 and 30, and is more common in males. Early symptoms include insidious onset of low back pain and morning stiffness that improve with activity and worsen with rest. Night pain that wakes patients in the second half of the night is characteristic. Without treatment, progressive spinal fusion can occur, leading to reduced mobility.
Peripheral joint involvement (hips, knees, ankles), enthesitis (inflammation where tendons attach to bone), and extra-articular manifestations (uveitis, inflammatory bowel disease) may also occur. HLA-B27 genetic testing and MRI of the sacroiliac joints are important diagnostic tools.
- Low back pain and morning stiffness — improves with activity
- Night pain in the second half of the night
- Peripheral joint involvement — hips, knees, ankles
- Enthesitis — Achilles tendon, plantar fascia, elbow
- Extra-articular — uveitis, inflammatory bowel disease
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Treatment and monitoring
NSAIDs are first-line therapy and should be used at adequate doses. Regular exercise, physiotherapy, and posture maintenance are essential components. TNF inhibitors (adalimumab, etanercept, infliximab) and IL-17 inhibitors (secukinumab) are indicated for active disease refractory to NSAIDs.
Involvement of peripheral joints, enthesitis, and extra-articular manifestations requires targeted management. Regular monitoring includes disease activity assessment (BASDAI score), spinal mobility measurements, and screening for cardiovascular risk and osteoporosis.
- NSAIDs — first-line, adequate doses
- Exercise and physiotherapy — essential, regular, lifelong
- TNF inhibitors — adalimumab, etanercept, infliximab
- IL-17 inhibitors — secukinumab
- Screening — cardiovascular risk, osteoporosis, uveitis