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Sacral Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a condition of the spine where spinal joints become inflamed, similar to Rheumatoid Arthritis. In both cases, the body sees these joints as foreign material and tells the immune system to attack it (autoimmune disease). In AS, all the spine joints including the sacroiliac joints can be affected. After long periods of severe inflammation of these joints, they eventually fuse (mend together) on their own, resulting in “stiff vertebrae”.

Are other organs also affected by Ankylosing Spondylitis?

Other organs such as the eyes, heart and kidneys can also be affected by this disease.

Who gets Ankylosing Spondylitis?

AS is a disease most commonly seen in males between 20-40 years of age, and is passed on through families (genetic link). 90% of patients with AS, have a specific gene (HLA-B27), which can be inherited.

What kind of symptoms do patients with Ankylosing Spondylitis get?

The initial symptoms of AS can be vague. This can make it difficult to diagnose the disease in its early stages.

On average, the first symptoms are present by the age of 23.

In more advanced stages, the following symptoms may be present:

  1. Stiffness in the back and other joints
  2. Pain in the spine, most often mid-back (thoracic spine)
  3. Pain in the buttock and thigh area (from sacroiliac joint pain)
  4. Loss of mobility of the spine

How do Spine Specialists diagnose Ankylosing Spondylitis of the Sacroiliac Joints?

Spine specialists use the information from the patient history, physical examination and specific tests to make this diagnosis:

  1. History

A history of slowly worsening stiffness and pain over the hip bones may tip a doctor off to the diagnosis.

A family history of AS can be very suggestive when a patient has symptoms.

      2. Physical Examination

AS can be difficult to diagnose with a physical examination. Here are some examination techniques a doctor may use:

  • Looking at the spine (inspection)
  • Touch and pressure of the spine (palpation)
  • Mobility testing (Range of Motion)
  • Sacroiliac joint testing:
    • Pelvic Rock test
    • Gaenslen’s test
    • FABERE’s test
    • Patrick’s test

      3. Tests

  1. Imaging
  • X-Rays

X-Rays of the Sacroiliac joints can show joint degeneration and loss of joint space. X-Rays may not show the disease in its early stages.

  • CT Scans

CT scans can show the bone anatomy of the spine and sacroiliac joints in detail. The loss of joint space from AS can be clearly seen in advanced cases.

  • MRI Scans

MRI scans can show degeneration and inflammation of the sacroiliac joints. The specific bone details are best seen on a CT scan.

  • Nuclear Bone Scan

Nuclear bone scans can show the severe inflammation in the Sacroiliac Joints clearly.

      2. Blood tests

  • HLA-B27, the genetic marker for AS can be found on a blood test
  • Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP)

Elevated levels of inflammatory markers in the blood can point towards an inflammatory spine conditions such as AS.

How is Ankylosing Spondylitis of the Sacroiliac Joints treated?

There is no cure for AS, but here are some treatments which can help with the symptoms.

          1. Non-Surgical

A. Medications

There are a number of medications available which depress the immune system. Since the immune system is attacking the joints in AS, depressing it can slow the disease or possibly put it in remission.

  1. Non-steroidal Anti-inflammatory Drugs (NSAIDS)
  2. Steroids
  3. Muscle Relaxants
  4. Pain Killers
  5. Nerve Pain Medications
  6. Physical Therapy (PT)

B. Exercises

Specific exercises to improve the sacroiliac joint mobility can lessen the symptoms. Aquatic therapy can also be very beneficial. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

C. Massage Therapy

Massage therapy techniques can help with the muscle components of AS.

D. Injections

Injections can offer some help for AS patients with earlier stages of the disease. Here are some injections with may help:

1. Sacroiliac Joint Injections

2. Sacroiliac Joint Radiofrequency Rhizotomy

E. Chiropractic Care

Chiropractic care such as spine manipulation can help with the mobility of the sacroiliac joint in the earlier stages of the disease.

F. Alternative Health Care

Alternative health options can often complement traditional medical care.

 

2. Surgical Care

Surgery for the sacroiliac joint may not be needed. However, here is a potential surgical option:

Sacroiliac Joint Fusion