Nine Ankylosing Spondylitis Complications to Know About

Hello and welcome to this episode of The Ankylosing Spondylitis Podcast. I hope everybody is doing well as we all face this lock down together across the country, across the world. Today I wanted to talk about an article I found in Creaky Joints, which is a website that I like to go to is creakyjoints.org and I'll have a link in the show notes. And it was really interesting because I've talked about a few of these items in previous episodes. The article is titled; Nine Ankylosing Spondylitis Complications you need to know about and it really deals with the comorbidities that we can encounter when we have Ankylosing Spondylitis. So as we all know, Ankylosing Spondylitis is a type of inflammatory arthritis that causes inflammation, you know, pain and stiffness, it predominantly affects the lower back spine and the sacroiliac joints, which are the joints where the spine meets up with the pelvis. Well, we asked what's behind all the inflammation that comes on and is basically body's immune system is releasing chemicals and attacking your joints causes pain, stiffness, and eventually long term joint damage. I've had that with my sacroiliac joints being fused, and the damage that was done to my hips, resulting in hip replacements. So compared with many other forms of arthritis, AS generally for most folks begins when they're young, I've seen people in some of the online forums say that they were diagnosed when they were as young as five, six years old. As I've said in other episodes, I had symptoms back as early as nine or ten that I'm aware of, and was diagnosed when I was 14. Many of us develop a lower back pain and it's worse when there's an activity or you know, when you wake up in the morning, you can have that stiff painful back and as you get moving in the day, it tends to lessen it can present an ongoing and dull pain throughout the day. That is like it's coming from deep within the lower back or towards your buttocks. Because back and hip pain are incredibly common. You know, it's easy for people with AS to chalk up the symptoms to other issues such as athletic or overuse injuries. AS symptoms aren't limited to our lower back. The disease can also affect like I said, the neck, peripheral joints, shoulders, knees, you know, hips, it can affect all of it. So all chronic inflammatory lower back pain can be a telltale sign of Ankylosing Spondylitis. The disease can have a wide-ranging impact on patient’s health and well being the inflammation and joint damage of as are linked with a number of additional complications. And it's important for us as patients to understand those and be aware of them and proactively try to prevent these or manage them as best we can. So let's go through these common Ankylosing Spondylitis, comorbidities and complications.

Number one - Ankylosing Spondylitis and forward curve of the spine. This is something that I deal with a lot spondylitis can cause overgrowth of the bones in your spine. This can lead to fusion, which is the abnormal joining of the bones. “By definition Ankylosing Spondylitis affects the sacroiliac joints in the pelvis first, and then marches its way up to the spine,” says Maureen Dubreuil, MD, assistant professor of rheumatology at Boston University School of Medicine who specializes in spinal arthritis. It may not follow that exact pattern, but you can have involvement at any part of the spine, the neck, ribcage, and lumbar spine, so in the past, people with AS, develop significant changes in their posture over time. That's what I deal with, I am hunched over quite a bit so that when I walk, I am looking down at the ground and not up. It's actually very challenging for me to walk and look forward at the same time. It develops excruciating pain in the back as I try to straighten the spine up and it's very visible on x rays where you can see that that growth in that fusion in the vertebrae and in the spine, so it's disheartening and alive. A lot of ways, but its part of the natural progression of the disease. And I encourage folks that as you start off and you learn about this diagnosis, work with your doctors work with the medications that are available to prevent this one, this is one that is not preventable, but, you know, early diagnosis and treatment can help possibly prevent it. So you want to do as much as you can to work against this one.

Number two - Ankylosing Spondylitis and Osteoporosis. Osteoporosis is a silent condition that weakens your bones and makes them more susceptible to fractures. It's a frequent complication of Ankylosing Spondylitis. According to the American College of Rheumatology, Osteoporosis occurs and up to half of the patients with Ankylosing Spondylitis, especially in those whose spine is fused. One thing that's kind of interesting that this article pointed out is that generally Osteoporosis is considered more of a woman's disease and AS is considered more of a mans disease. I've tackled that misconception about AS being more of a man's disease in several prior episodes. However, we know that AS affects much more women than previously thought, and that number is going up every year as women are being properly diagnosed. And it's important for women with AS to be aware of this additional Osteoporosis risk factor and for men with AS to keep Osteoporosis on their radar. So make sure you talk to your rheumatologist about Osteoporosis and make sure that if you're starting to have fusing done, you get the bone density scan done, and they can look at both your wrist, your hip and some other areas to tell you what your bone density is looking like.

Number three - Ankylosing Spondylitis and Uveitis. As many as 40% of people with Ankylosing Spondylitis may experience a kind of inflammation in the eye called uveitis and that's from the American College of Rheumatology, Uveitis causes swelling of the uvea which is the layer of tissue in the middle of your eye beneath your cornea. The symptoms are extremely painful, and you'll know it when it comes on. It's just a pain that's very hard to describe until you've actually had it happen. But it's also one of the things to know that because it's a systemic disease, Ankylosing Spondylitis, Uveitis taking place or happening and you might mean that inflammation is out of control in your body and it's time to talk to your rheumatologist after you get it under control about some things you might be able to do to bring your inflammation back in line or under control. Make sure to visit with an Ophthalmologist at least annually to get your eyes looked at and understand or discuss with your doctor that again, if you have recurrent bouts of uveitis, it may mean that it's time to look at updating or changing the treatment plan that you're doing for Ankylosing Spondylitis.

Number four - Ankylosing Spondylitis and Inflammatory Bowel Disease. Inflammatory diseases tend to travel in packs inflammation from Ankylosing Spondylitis can also strike the intestinal tract which makes such diseases as Crohn's and Ulcerative Colitis common among Ankylosing Spondylitis patients. In fact, it's estimated between 5% and 10% of cases of Ankylosing Spondylitis are associated with inflammatory bowel diseases. According to a study that was done in the Journal of Best Practice and Research Clinical Rheumatology, some two thirds of people with AS have bowel inflammation without symptoms that is seen only by a colonoscopy. This was found in the British Journal of Rheumatology. Sometimes people don't even realize that they have inflammatory GI issues. Since they're experiencing so much back pain. It's unclear why as is linked to inflammatory bowel disease. As Dr. Dubreuil says, we're just really beginning to understand why these two things are connected. One possible explanation is that there's a change in gut bacteria that leads to inflammation that both affects the GI tract and the joints in the spine and elsewhere in the body. So symptoms of inflammatory bowel disease include potentially chronic diarrhea, blood in the stool, stomach pain, cramping and other digestive problems. If you have these symptoms, you may need a colonoscopy to see what's happening in the GI tract. Biologic medications used to treat AS may also be beneficial in managing ulcerative colitis or Crohn's disease. If you have inflammatory bowel disease, a gastroenterologist can work with you and your rheumatologist on the treatment plan. In addition to medication, they may suggest tweaks to your diet, such as limiting dairy eating low fat foods, avoiding butter, creamer sauces, fried foods, and restricting high fiber foods depending on your condition. 

Number five - Ankylosing Spondylitis and Psoriasis. Psoriasis is an autoimmune disorder characterized by red, itchy, silvery scaly patches on the skin. Psoriasis is known to co-occur with Ankylosing Spondylitis. So if you develop any of those issues if your skin develops patches talked rheumatologists, they will likely refer you to a dermatologist who will examine your skin nails scalp for signs that condition your dermatologist and rheumatologist can work together on a treatment plan to address both psoriasis and as psoriasis may be treated with topical medications like corticosteroids, photo therapy, which is the ultraviolet or natural light systemic treatment like methotrexate or a combination approach. Some biologic medications may also help to treat both psoriasis and AS. 

Number Six - Ankylosing Spondylitis and Heart Disease. People with Ankylosing Spondylitis may be at an increased risk for developing certain heart problems likely due to a combination of inflammation that we deal with and then the lack of exercise that many of us deal with due to symptoms like the pain and stiffness. Medications used to treat Ankylosing Spondylitis can also play a role and nsaid's may increase cardiac risk something like a TNF inhibitor, biologic can help decrease inflammation and cardiac risk. So make sure with Ankylosing Spondylitis that you're doing the most you can for heart health. If you're smoking stop the chemicals could damage the lining of the arteries and 

contribute to plaque buildup that can cause heart attack or stroke. If you're overweight, lose weight extra pounds strain your heart and put you at a higher risk of high cholesterol and blood pressure control conditions like diabetes that can damage your blood vessels, your heart exercise regularly as best you can, you know that can help to strengthen your cardiovascular system. One heart condition as patients need to be aware of is the potential of having aortic valve disease though it is considered rare. The order is the main artery in the heart that sends blood from your heart to everywhere else in your body. Inflammation in the aorta can cause arthritis and can harm the aotic valve that helps blood flow in the correct direction. So again, with Ankylosing Spondylitis, make sure that you talk to your doctor so that you can always get that complete physical that you need to be looked at to cover all conditions.

Number Seven - Ankylosing Spondylitis and Depression. This is one that we know and it doesn't take just a shut in or pandemic to create the depression recent research published in the Journal of Scientific Reports found that having Ankylosing Spondylitis more than doubles your risk of depression. We don't know if this is related to the disease process itself where people with chronic inflammatory diseases tend to have high levels of immune system proteins called cytokines, which trigger inflammation and may also contribute to depression. AS patients may also experienced depression, anxiety, because of how the disease and its symptoms are affecting quality of life and the ability to work and socialize. So we know that we're at higher risk for depression. Make sure that if you're even thinking that you're dealing with depression that you're talking with family therapist, Minister, priest, whoever you need to consult with and get on the right path. There's nothing wrong with seeking out assistance for depression. And I highly encourage everybody to do it. It is a very good process to go through to help in many ways to come to terms with what your new life is like when you're dealing with Ankylosing Spondylitis. So, again, your rheumatologist and your primary care physician, they may be able to help you with some medication to deal with depression. And this can help in conjunction with therapy. Exercise can also help because of the endorphins that it releases. So just do the best with everything that you can do to make sure and and catch that depression and deal with it early on.

Number Eight - Ankylosing Spondylitis and Heel Pain. When you have Ankylosing Spondylitis, you can have pain and tenderness in spots where soft tissues meet bone, which is known as enthesitis. It's a common symptom of Ankylosing Spondylitis, and it's also fairly common in the general population. So it doesn't always raise a lot of suspicion according to doctors. But people with Ankylosing Spondylitis commonly have Achilles tendinitis at the back of the heel and plantar fasciitis at the bottom of the foot, the same medications that manage Ankylosing Spondylitis inflammation and since and biologic should also help to alleviate some of this. So make sure that if you're suffering from heel pain, you're talking with your doctor about it. If your medications that you're on for Ankylosing Spondylitis aren't working, discuss other options, other medication options and just continue to delve into what's going to be best and work for you.

Number Nine - Ankylosing Spondylitis and fatigue. Fatigue which is that full body exhaustion you know, not just feeling tired from when you don't sleep well, but that just whole anything you do just you don't seem to have the energy to do anything as a better way to say it. It's a common complaint of many chronic illnesses and Ankylosing Spondylitis is no exception with untreated AS the cytokines which are inflammatory markers. You know they're going all through our body and our body is trying to use energy to calm this inflammation, which causes fatigue. This inflammation as well as the cycles of flares poor sleep and stress from AS are also to blame for fatigue. We know that higher levels of fatigue are associated with worse performance at work and more activity impairment among Ankylosing Spondylitis patients. According to a study that was done in the Journal of arthritis research and therapy. The research found that fatigue is an A a symptom that is often been ignored, but it's an important one treating as inflammation with biologics may help to improve the fatigue and restore energy level. Regular exercise can help such as you know, swimming, biking, yoga, whatever your body is capable of handling exercises an important part of treatment for anyone with fatigue physicians should also see if fatigue could be due to other causes such as anemia, sleep apnea, sub optimal pain management, so mine is a lot of times due to sleep apnea, as well as anemia and I had low testosterone that was also causing it. So once those were brought into control, my fatigue levels went way, way down. 

You know, those are nine of the items that can be comorbidities with Ankylosing Spondylitis, you're likely not going to have all of them, but just one or two is going to affect and make your ankle closing spondylitis just that much worse. So I encourage you to talk with your doctors. I know that's really hard right now. Well, we all have, you know, telephone appointments with doctors; we're not being seen in person. So again, when I did the other episode not too long ago on the app, that's a great way to make sure that you're chronicling your situation and can share it best with your doctor even if you have to download it or email it to them. It allows you to track on a day-by-day basis, what you're dealing with. I hope everybody stays safe. I hope nobody's dealing with too many issues related to the COVID-19 problem that they World is encountering and I look forward to talking to you in the future, everybody, please take care and have a wonderful day.

Creaky Joints article - https://creakyjoints.org/comorbid-conditions/ankylosing-spondylitis-complications/