Last updated on June 30, 2023
Hello. My name is Dr Peter Landsberg. I’m a rheumatologist at ArthritisCARE in Brisbane.
I’m just going to talk to you briefly about a condition called Ankylosing Spondylitis which is one of the conditions that rheumatologists are very effective in treating.
Ankylosing Spondylitis is an auto-immune disorder, more common in men than in women, but relatively common in both, affecting one in every 100 or 200 people.
It is a condition of inflammation of joints, ligaments and particularly the spine. Often the first symptom is just terrible pain around the lower back and in the buttocks. Often in young men.
It gradually creeps up the back and people become very stiff and sore without treatment. It can also cause swelling of the joints. So it is not uncommon to have someone with a sore back along with a swollen knee or a swollen ankle.
It can also affect ligaments. So again, you’ll also see young men with a sore back, a sore knee and a very painful achilles tendon. The morning stiffness is overwhelming and often the reason people first come to see us.
It doesn’t show up on x-rays for quite a long time, so the diagnosis is really based on this intense set of symptoms and signs.
Blood tests can show high levels of inflammation and that makes the doctor very suspicious. The examination is often very dramatic and young men who should normally be able to touch their toes quite easily can just barely get their hands down to their knees.
They may also have a sore chest, a sore neck, sore joints, sore ligaments and painful tendons.
The pain does respond very well to anti-inflammatories so patients will often say, “I’ve got this terrible back Doc, but if I take some Ibuprofen, I feel much better.” And that’s actually very suggestive of Ankylosing Spondylitis.
Other things like just a normal sore back, a torn muscle or a bulging disc won’t respond to anti-inflammatories, so this is one situation where the response to a drug can almost make the diagnosis.
It is caused by having genes that make us respond badly to simple bacteria passing through our gut. We can test for some of those genes, but blood tests are awkward as the gene that is seen in Ankylosing Spondylitis is seen very commonly in healthy, normal people. So, just having the gene does not mean that you will get Ankylosing Spondylitis.
I often see patients with back pain whose doctor has done a gene test, and although the gene test is positive, they don’t have Ankylosing Spondylitis. So you can’t rely on the gene test to make a diagnosis.
It is an interesting condition where having a particular group of genes will make us respond badly to certain bowel bacteria. The immune cells get caught up in those bacteria and leave the bowel ending up in our back, our ligaments or our joints where they have a very nasty party.
It’s a chronic ongoing condition, with treatment mainly being exercise and stretches and very, very effective medication. So now we switch off the disease with medication and strongly encourage people to run, walk, or ride a bike for half an hour every day with stretches or yoga every day. Exercise literally stops people from becoming stiff.
Early in the disease, we can use MRI scans to pick up the disease even before we can see it on x-rays. But if a person has had the condition for many years, on the x-rays you can see little areas of calcification forming in the spine and that’s the thing we are trying to avoid with early diagnosis and treatment.
Once upon a time, it was an awful disease. When I was a young doctor, any person with Ankylosing Spondylitis would often end up very stooped over and really often have to go on a pension. But now we have young men with Ankylosing Spondylitis playing rugby, football or cricket.
Many famous people have Ankylosing Spondylitis and with treatment are back playing professional golf or professional cricket etc. So, in twenty years we have gone from a disease that put people on the pension, to now being an inconvenience once it is diagnosed and treated well.
So it is imperative that if a person has low back pain and terrible stiffness, your doctor should consider Ankylosing Spondylitis and send you on for an assessment.