How Is Ankylosing Spondylitis Diagnosed
There isnt a test that definitively diagnoses ankylosing spondylitis. After reviewing your symptoms and family history, your healthcare provider will perform a physical exam. Your provider may order one or more of these tests to help guide diagnosis:
- Imaging scans:Magnetic resonance imaging scans can detect spine problems earlier than traditional X-rays. Still, your provider may order spine X-rays to check for arthritis or rule out other problems.
- Blood tests: Blood tests can check for the presence of the HLA-B27 gene. About 8% of people of European descent have this gene, but only a quarter of them develop ankylosing spondylitis.
Diagnosing Osteoarthritis Of The Spine
Physicians and surgeons at NYU Langone have extensive experience in diagnosing osteoarthritis of the spine, even when symptoms are mild. Osteoarthritis occurs when the spinal joints, called facet joints, deteriorate and become less functional. This condition usually results from aging, when the joints wear down after years of repeated everyday motions. Osteoarthritis of the spine is most common in people over age 40.
Degeneration of the facet joints often begins with the erosion of cartilage, a smooth tissue that lines the ends of bones in the joints and helps bones move together comfortably. If cartilage in the joint erodes, bones rub directly against each other, causing inflammation and irritation that lead to symptoms such as aching pain, often in the lower back or neck, and stiffness, which may limit mobility. For many people, pain and stiffness are most noticeable first thing in the morning or just before bed.
Repeated friction between bones can lead to the development of small bony growths called osteophytes, or bone spurs. These can get in the way of a nerve as it exits the spinal canal, creating whats called a pinched nerve. When this occurs, compression may cause pain separate from the discomfort caused by osteoarthritis itself. Pain caused by a pinched nerve often travels, or radiates, down the legs or into the arms. You may also notice numbness, tingling, or weakness in the limbs.
What Are The Symptoms Of Spinal Arthritis
Symptoms of spinal arthritis may differ from person to person. In general, they may include:
Back and neck pain, especially in the lower back
Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck
Swelling and tenderness over the affected vertebrae
Feeling of grinding when moving the spine
Pain, swelling and stiffness in other areas of the body
Whole-body weakness and fatigue
Pain and numbness in your arms or legs if the nerves are affected
Although back pain is a common symptom, not all people have it, even those with advanced spinal arthritis. On the other hand, some may experience pain even before arthritis can be seen on an X-ray.
In certain types of spondyloarthritis, eye inflammation may occur, causing pain, watery eyes and blurred vision.
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How Is Spinal Arthritis Treated
The treatment for spinal arthritis depends on many factors. They may include your age, level of pain, type and severity of arthritis and personal health goals. Because the joint damage caused by arthritis is irreversible, the treatment usually focuses on managing pain and preventing further damage.
Nonsurgical treatments for spinal arthritis may include:
Nonsteroidal anti-inflammatory drugs and corticosteroids to reduce pain and swelling
Other medications targeting specific symptoms or triggers of inflammatory arthritis
Physical therapy to improve back muscle strength and range of motion in the spine
Lifestyle changes to reduce inflammation or stress on your spine: losing weight, quitting smoking, changing your posture, etc.
How Is Ankylosing Spondylitis Managed Or Treated
Ankylosing spondylitis is a lifelong condition. While theres no cure, treatments can prevent long-term complications, reduce joint damage and ease pain. Treatments include:
- Exercise: Regular physical activity can slow or stop disease progression. Many people experience worse pain when theyre inactive. Movement seems to lessen pain. Your healthcare provider can recommend safe exercises.
- Nonsteroidal anti-inflammatory drugs :NSAIDs, including ibuprofen and naproxen , ease pain and inflammation.
- Disease-modifying anti-rheumatic drugs : Medications such as sulfasalazine reduce pain and joint swelling. The drugs also treat lesions caused by inflammatory bowel disease. Newer DMARDs called biologics help control inflammation by changing the immune system. Biologics include tumor necrosis factor and interleukin inhibitors .
- Corticosteroids: Injectable corticosteroids temporarily ease joint pain and inflammation.
- Surgery: A small number of people with ankylosing spondylitis may need surgery. Joint replacement surgery implants an artificial joint. Kyphoplasty corrects a curved spine.
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What Is Ankylosing Spondylitis
Ankylosing spondylitis is a form of arthritis that causes chronic spine inflammation. Ankylosing spondylitis inflames the sacroiliac joints located between the base of the spine and pelvis. This inflammation, called sacroiliitis, is one of the first signs of AS. Inflammation often spreads to joints between the vertebrae, the bones that make up the spinal column. This condition is known as spondylitis.
Some people with AS experience severe, persistent back and hip pain and stiffness. Others have milder symptoms that come and go. Over time, new bone formations may fuse vertebrae sections together, making the spine rigid. This condition is called ankylosis.
How To Treat Oa Of The Spine
Theres no cure for osteoarthritis of the spine, and the condition isnt reversible. The goal of treatment is to relieve pain and to improve the mobility of the affected joint. Your doctor can discuss possible treatment options with you. Mild cases of OA of the spine may respond to over-the-counter medications such as acetaminophen . Take this medication as directed to avoid liver damage. You can also relieve pain and inflammation with ibuprofen and naproxen sodium . Side effects of these medications include upset stomach, bleeding problems, and organ damage, so its important to take as directed.
If symptoms dont respond to over-the-counter medication, your doctor may suggest antidepressants used to treat chronic pain. Another option is a corticosteroid injection directly into affected joints. Surgery isnt a common treatment for OA of the spine, but in severe cases you doctor may recommend a procedure to replace damaged discs in your spine.
Other therapies for treating and coping with osteoarthritis of the spine include:
- gentle exercises to reduce pain and improve range of motion in the remaining cartilage
- heat or cold therapy
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How Is Osteoarthritis Of The Spine Diagnosed
The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.
The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:
- X-rays to look for bone damage, bone spurs, and loss of cartilage or disc however, X-rays are not able to show early damage to cartilage.
- Blood tests to exclude other diseases
- Magnetic resonance imaging to show possible damage to discs or narrowing of areas where spinal nerves exit
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What Are The Symptoms Of Osteoarthritis Of The Spine
Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down.
Some people experience little interference with the activities of their lives. Others become more severely disabled.
In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.
How Arthritis In The Back Is Treated
Treatment for back arthritis depends on many factors, including your age, level of pain, type and severity of arthritis, other medical conditions and medications, and personal health goals. Because joint damage caused by arthritis is irreversible, treatment usually focuses on managing pain and preventing further damage.
Can Lumbar Arthritis Be Prevented
Your age, family history, and gender can all contribute to arthritis development. Although these factors are outside of your control, there are certain things that you can do to limit the pressure on your vertebrae. Reduced pressure may prevent flares of lumbar arthritis or other symptoms.
To reduce your risk of flare-ups:
Maintain a healthy weight. Carrying excess weight can put unnecessary stress on your joints.
Opt for low-impact exercise. Stretching, yoga, and swimming can all relieve pressure on your back.
Move with care. When dealing with heavy objects, be sure to lift with your knees and not with your back.
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Symptoms Of Arthritis Of The Spine
Spinal arthritis causes stiffness and low back pain. The stiffness is worst upon waking up in the morning, tends to ease with activity, then worsens toward the end of the day. Presumably, this is because fluid has built up in the joint due to inactivity overnight, which causes more swelling.
The low back pain due to facet joint arthritis has a typical pattern:
- The pain is mostly more than 80% in the back, runs into the buttocks, and often really feels like its in the hip.
- As it gets even worse people often report burning on the outer aspect of the thigh, and sometimes pain down the leg.
Can You Detect Arthritis In An X Ray
The above image is the X-Ray image of knee arthritis, which is a very common form of osteoarthritis among the older groups of people. According to the study, around 10% male and 13% female over the age of 60 are diagnosed with knee osteoarthritis. We can see how the knee of the patients suffering from arthritis is different from the knee of a normal person.
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Ankylosing Spondylitis Treatment May Include:
MedicationsAs with more common osteoarthritis, treatment often begins with non-steroidal anti-inflammatory medications . Although most patients’ symptoms respond well to anti-inflammatory medication, these drugs do not treat the underlying disease. Sometimes medications are not strong enough.
Unlike osteoarthritis, in inflammatory arthritis, certain medications can affect the actual disease. For example, TNF-blocking drugs may help block a protein that can cause inflammation . Adalimumab , etanercept and ixekizumab are three types of TNF-blockers that may stop disease progression.
Physical therapy, therapeutic exercisePhysical therapy stresses proper posture, joint mobility, and deep breathing. Some patients may develop forward posture therefore, postural training and extension exercise is helpful. Stretching and range of motion exercise helps keep the facet and rib joints mobile. Additionally, deep breathing expands the chest and aids lung function.
Arthritis In Fingers And Hands
It is estimated that 40% of all adults in the United States will be diagnosed with osteoarthritis in at least one hand before the age of 85, with women being twice as likely as men to develop symptoms.
Arthritis of the hands and fingers causes painful inflammation and swelling of the joints of the wrists and fingers, making activities like gripping, grasping, and pinching very challenging and painful. Over time, arthritis can cause noticeable deformation of the finger joints.
Medications, cortisone injections, splinting, physical therapy, and activity modification can all be used to help manage symptoms. If arthritis affects the thumb joint and conservative measures fail to improve symptoms, a trapeziectomy may be performed to decrease joint pain and inflammation.
Illustration by Cindy Chung, Verywell
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What Are The Different Types Of Arthritis That Affect The Back
There are several types of arthritis. The different types of arthritis that may affect the back or neck include
- Osteoarthritis of the spine: This is noninflammatory, degenerative arthritis. It is the most common form of arthritis that affects the back. Wear and tear seem to be the reason that osteoarthritis develops.
- Rheumatoid arthritis of the spine: This is an autoimmune disorder where the lining of the joints is affected. Its a type of inflammatory arthritis because wear and tear on the joints is not involved.
- Fibromyalgia: This causes chronic, widespread muscle pain and fatigue.
- Spondyloarthritis: This is a group of inflammatory diseases that affects both the joints and the areas where the ligaments and tendons are attached to the bones. There are several forms of spondyloarthritis, including
- Ankylosing spondylitis: This is a type of spinal arthritis that causes inflammation of the vertebrae and the joints at the base of the spine.
- Psoriatic arthritis: This is an autoimmune disorder triggered by psoriasis and it is characterized by an itchy, scaly rash.
- Reactive arthritis: In this type of arthritis, a gastrointestinal or genital infection probably triggers joint inflammation. It usually affects the lower back.
- Enteropathic arthritis: This is a type of arthritis linked to inflammatory bowel disease.
- Undifferentiated spondyloarthritis
Ankylosing Spondylitis: A Type Of Spinal Inflammatory Arthritis
Ankylosing spondylitis is a chronic inflammatory spinal disease characterized by joint pain and progressive stiffness in the cervical , thoracic , lumbar , and sacroiliac joints . AS is also known as radiographic axial spondyloarthritis.
AS is categorized by enthesopathy, which means an inflammatory attack where tendons and ligaments attach to bones or joint capsules . In the spine, the primary site for this enthesis is where the long spinal ligament attaches to the front of the vertebrae. Inflammation of the enthesis is called enthesitis.
The onset of AS is usually seen in people ages 15 to 45 years. Early symptoms may be similar to arthritis low back and buttock pain and stiffness that are worse in the morning and night. Some patients experience loss of appetite and mild fevers.
The onset of AS is usually seen in people ages 15 to 45 years. Early symptoms may be similar to arthritis. Photo Source: 123RF.com.
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What Are Some Of The Other Methods To Diagnose Osteoarthritis
Besides the appearance of arthritis on X-ray, there are some other tests as well that are performed by the doctors to know better about the patients condition. Before the X-Ray test, the doctor will ask some questions to study your symptoms. The doctors will ask these things to the patient.
- The degree of pain
- How long have you been suffering from this pain?
- What kinds of activities are difficult to perform because of the pain or decreased mobility?
After reviewing the symptoms, the doctor will perform some physical examinations to know about these things:
- See if there is a swelling in the joint, as it could be a sign of excess fluid.
- Check if the muscle is thinning or not
- Check out joint mobility to see if it is normal or not
- Joint tenderness
- The grating sounds while moving the joints, which is called crepitus
- Swelling in the bones
- Joint instability
Some other forms of tests that doctors may include are as follows:
- Blood tests: The blood tests are usually not necessary to diagnose osteoarthritis however, the doctor may ask the patient to test their blood for ruling out other possible diagnoses.
- Joint fluid analysis: The doctor will use the needle for withdrawing the fluid if there is an excess swelling around the joints. The fluid will be used by the doctor to see if the patient has an infection, gout, or some osteoarthritis-related inflammation.
Exercise For Arthritis In The Neck
If youre experiencing neck pain due to arthritis, your doctor may recommend physical therapy. Physical therapy for neck arthritis entails doing specific exercises to help strengthen and stretch weak or strained muscles. Physical therapy can improve range of motion. Sessions and programs vary in length and frequency and are tailored to your condition.
The foundation of what were trying to do in physical therapy for the neck is often to help improve posture and the way people move, says Dr. Milani. Exercises in physical therapy tend to be focused on strengthening muscles of the back and neck, which puts less strain on structures of the cervical spine.
Youll do exercises during physical therapy and get instructions on ones to do at home.
Regular Physical Activity at Home
You may feel like you dont want to move when your neck hurts. But being inactive may increase stiffness, which can cause you to lose even more mobility. Aches and pains tend to respond better to continued movement than rest, says Dr. Milani. Exercise is often the foundation of treatment.
Exercises that involve stretching, strengthening, and improving range of motion can help reduce pain and keep your neck limber. You want to move gently and smoothly when doing neck exercises, not jerk your neck or make sudden movements. You may feel discomfort at first. Stop if any exercise increases your neck pain.
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What Causes Osteoarthritis
The most common form of arthritis, osteoarthritis, is associated with injuries, wear-and-tear processes, and genetics. An arthritis joint will demonstrate the narrow bone spaces due to various reasons. The cartilage thins, the formation of cysts within bones, bones spurs seen on the edges, deformity of joints are some of the reasons, which leads to crooked joints.
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