Understanding Ankylosing Spondylitis: Insights from a Rheumatologist in Singapore
Home • Articles • Understanding Ankylosing Spondylitis: Insights from a Rheumatologist in Singapore
What is Ankylosing Spondylitis?
Are you suffering from long-term lower back pain? If so, you could have Ankylosing spondylitis (AS) because approximately 5% of people with lower back pain may have spondyloarthritis (a group of inflammatory diseases that includes ankylosing spondylitis).
AS is a chronic inflammatory form of arthritis that primarily targets the spine. The autoimmune condition typically emerges before age 40 and can lead to symptoms like back and large joint pain, stiffness, and restricted movement. In particular, a defining symptom of AS is lower back and buttock pain that worsens with rest or inactivity, often causing pain at night during rest, early morning stiffness or pain after prolonged sitting. In the late stage of AS, the fusion of joints typically leads to a severe decrease in the flexibility and mobility of the spine. This restriction in movement can make everyday activities such as bending, twisting, and even walking difficult.
It is important to note that the severity of AS symptoms may vary among individuals, with some experiencing periodic flare-ups and others facing chronic pain. Over time, AS can affect other parts of the spine and body, underscoring the importance of early diagnosis and proactive management.
What causes Ankylosing Spondylitis?
The exact cause of AS remains largely unknown, but it's believed to stem from a mix of genetic and environmental factors. The main genetic factor linked to AS is the HLA-B27 gene, found in nearly 90% of people with the condition.
However, having this gene doesn't guarantee you will develop AS — only about 1-5% of people with the HLA-B27 gene do. Environmental factors like infections or other triggers can also play a role in the onset of AS.
How common is Ankylosing Spondylitis in Singapore, and who is at risk?
AS is a relatively rare autoimmune condition in Singapore, AS affects approximately 2 to 10 in 1,000 people. It typically occurs in late adolescence or early adulthood (i.e., between ages 15 and 35) and is 2-3 times more prevalent in men than women. Risk factors contributing to the condition include genetics, family history, smoking, history of previous infections and certain medical conditions (e.g., Crohn’s disease, ulcerative colitis, psoriasis and uveitis).
How does Ankylosing Spondylitis affect daily life?
Ankylosing Spondylitis (AS) affects daily life in several ways:
Reduced Mobility: AS primarily impacts the spine, causing stiffness and discomfort that can make bending, twisting, and walking difficult. Morning stiffness often requires extra time to alleviate, interfering with daily routines.
Chronic Pain: Persistent pain is a hallmark of AS, which can be exacerbated by inactivity. This pain can disrupt sleep and lead to constant discomfort throughout the day.
Fatigue: The body's ongoing battle against inflammation can lead to significant fatigue, reducing energy levels and making it hard to stay physically active.
Impact on Daily Activities: The physical limitations and pain caused by AS can hinder one's ability to perform everyday tasks, affecting overall quality of life.
What are the complications of Ankylosing Spondylitis?
Reduce flexibility - Ankylosing spondylitis (AS) primarily impacts the sacroiliac joints and the lumbar spine (lower back) at the onset, but it can also extend to the cervical and thoracic spine. Persistent inflammation in these regions may eventually cause the spine to stiffen and fuse, referred to as a bamboo spine. The condition can also involve other joints, tendons, and ligaments.
Eye inflammation - people with ankylosing spondylitis (AS) may develop eye inflammation known as uveitis, which causes pain in the eye, blurred vision and sensitivity to light.
Osteoporosis - as the bones weaken, AS patients are at an increased risk of spinal fractures due to osteoporosis.
People with ankylosing spondylitis (AS) may also have concomitant conditions such as psoriasis or inflammatory bowel disease, including Crohn's disease or ulcerative colitis.
Cardiovascular disease - people with AS may have a higher risk of cardiovascular diseases such as heart attack.
Cauda equina syndrome- a rare complication of long-standing AS, which results from damage to nerves of the lower back. Symptoms include abnormal sensation and weakness of the lower limbs as well as urinary and faecal incontinence.
Can Ankylosing Spondylitis be cured?
Unfortunately, there is no cure for AS at the moment. AS is a lifelong disease that typically progresses over time, potentially leading to significant complications if not managed properly. Thankfully, with proper management of their condition, most patients with AS can lead long, fulfilling lives and maintain a good quality of life
How do you treat Ankylosing Spondylitis in Singapore?
When it comes to managing AS in Singapore, there are various treatment options to consider. These may include a combination of medications, physical therapy, and lifestyle changes, as recommended by rheumatologists—medical doctors who specialise in your body’s musculoskeletal and immune systems—in Singapore. For an appropriate treatment plan, consult with a specialist at a rheumatology centre in Singapore, who can provide expert advice and help you navigate treatment options.
What are the dos and don’ts for people living with Ankylosing Spondylitis?
AS can significantly impact lifestyle, but patients can maintain a good quality of life with the right approach. At Asia Arthritis & Rheumatology Centre, we advise patients with AS to adopt the following general tips to navigate daily life with AS:
Dos
Attend Regular Rheumatology Clinic Check-ins in Singapore Stay in touch with your rheumatologist and follow her guidance. Take your meds as prescribed and keep up with recommended activities. Be transparent about your symptoms and any side effects to ensure your treatment is on track.
Exercise Frequently Stay physically active to maintain mobility and flexibility, as well as alleviate discomfort. Avoid high-impact activities like running or heavy lifting that can exacerbate joint pain and cause further damage. Try low-impact hobbies like swimming, pilates, yoga, and tai chi, which are gentler on your joints and great for stretching the spine. But don't overlook the importance of cardio and strength training. Moreover, remember to listen to your body — do not overexert yourself.
Use Assistive Devices When Necessary
If you're experiencing significant pain or difficulty with movement, don't hesitate to use assistive devices like canes or walkers. These can help reduce strain on your joints and prevent falls.
Mind Your Posture Focus on keeping your spine straight. Some patients may want to slouch to ease the pain. However, bending the spine strains it further, which can exacerbate discomfort. Patients may also benefit from sleeping on a firm mattress with a thin pillow, and practising standing against a wall with heels, bottom, shoulders, and head touching.
Eat Healthily An anti-inflammatory diet, rich in fruits, vegetables, whole grains, and healthy fats, can help reduce inflammation, potentially alleviating AS symptoms such as pain and stiffness.
Practice Breathing Exercises
Engaging in deep breathing exercises can help expand your chest and improve lung capacity, which is often restricted in AS patients due to chest wall stiffness.
Don’ts
Avoid Smoking Smoking can speed up joint damage and hinder treatment effectiveness, while increasing the risk of other diseases often associated with AS, such as heart problems.
Don’t Miss Out on Sleep Pain from AS can make it hard to sleep, which in turn can worsen your pain and leave you feeling even more exhausted. That's why it's crucial to practise good sleep habits, such as getting enough sleep, maintaining a regular sleep schedule and engaging in relaxing bedtime routines, for better rest and overall well-being.
Bear in mind that the aforementioned tips are just the rule of thumb. As the condition of each patient varies, our experienced Senior Consultant Rheumatologist will thoroughly assess your individual condition and provide specialised advice accordingly.
Advice from your Rheumatologist: How to live with Ankylosing Spondylitis
While AS can cause permanent damage and loss of motion if not managed properly, it's generally quite manageable with the right approach. Early diagnosis, appropriate treatment and lifestyle choices, as highlighted above, are key to keeping symptoms in check and enhancing quality of life. So, don't ignore backache or stiffness that lasts more than three months — seek specialised advice from a rheumatology specialist in Singapore to reduce the risk of complications.
At Asia Arthritis & Rheumatology Centre, Dr Annie Law, our Senior Consultant Rheumatologist and Medical Director, is well-versed in AS. Book a consultation with her for tailored, expert advice on AS.
Gracey, E., Yao, Y., Green, B., Qaiyum, Z., Baglaenko, Y., Lin, A., Anton, A., Ayearst, R., Yip, P., & Inman, R. D. (2016). Sexual Dimorphism in the Th17 Signature of Ankylosing Spondylitis. Arthritis & Rheumatology, 68(3), 679–689. https://doi.org/10.1002/art.39464
Sieper, J., Braun, J., Rudwaleit, M., Boonen, A., & Zink, A. (2002). Ankylosing spondylitis: an overview. Annals of the Rheumatic Diseases, 61(Supplement 3), 8iii18. https://doi.org/10.1136/ard.61.suppl_3.iii8
For enquiries, leave a message and our friendly team will get in touch with you. For urgent enquiries after office hours, call or WhatsApp us at (65) 8030 7862.
