Spondylitis refers to inflammation of the vertebrae, most commonly seen in Ankylosing Spondylitis (AS), a chronic inflammatory arthritis affecting the spine and sacroiliac joints. Over time, the inflammation can lead to stiffness, reduced mobility, and fusion of the spine. Early diagnosis and proper treatment help prevent disability and improve quality of life.
Causes and Risk Factors
- Autoimmune reaction
- Genetic factor: presence of HLA-B27 gene
- Family history of spondylitis or other autoimmune diseases
- More common in males
- Age: usually begins in late teens or early adulthood
Symptoms of Spondylitis
- Chronic lower back pain
- Morning stiffness lasting more than 30 minutes
- Pain improves with movement but worsens with rest
- Reduced flexibility of the spine
- Hip and buttock pain
- Fatigue
Extra-Spinal Symptoms
- Eye inflammation (uveitis)
- Chest expansion limitation
- Heel pain (enthesitis)
- Weight loss
Diagnosis
- Clinical history and physical examination
- X-rays of sacroiliac joints
- MRI – detects early inflammatory changes
- Blood tests: ESR, CRP (elevated in active disease)
- HLA-B27 testing
Treatment Goals
- Reduce pain and inflammation
- Maintain posture and spinal mobility
- Prevent long-term deformities
Treatment Options
1. NSAIDs (First-Line Drugs)
- Ibuprofen
- Naproxen
- Indomethacin
2. DMARDs
Used mainly when peripheral joints are involved.
- Sulfasalazine
- Methotrexate (less effective for spine involvement)
3. Biological Agents
Used in moderate to severe, treatment-resistant cases.
- TNF inhibitors – etanercept, adalimumab, infliximab
- IL-17 inhibitors – secukinumab
4. Physical Therapy
- Stretching exercises
- Posture correction
- Breathing exercises
- Strengthening of back muscles
5. Lifestyle Measures
- Regular exercise
- Quit smoking
- Maintain healthy weight
- Use firm mattress to support the spine
Complications of Spondylitis
- Spinal fusion (severe stiffness)
- Postural deformity (forward bending posture)
- Limited chest expansion
- Uveitis
- Osteoporosis
Patient Counseling
- Perform spine and stretching exercises daily
- Take NSAIDs and other medications as prescribed
- Maintain correct posture during sitting and sleeping
- Report eye pain or redness immediately (uveitis risk)
- Avoid smoking, as it worsens lung and spine health
Detailed Notes:
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