Ankylosing Spondylitis - Symptom, Treatment And Causes

The human spine has 33 vertebrae. However, some conditions can fuse these vertebrae. Ankylosing Spondylitis is one such condition. This disease may also be known as AS or Bechterew's disease. It is an inflammatory disease that can make the spine less flexible by fusing the vertebrae of the lower back together. In some cases, it can also affect the rib cage and make it difficult to breathe. This disease typically affects more men as compared to women. Most patients begin showing symptoms in early adulthood.

Ankylosing Spondylitis affects the sacroiliac joints. These joints are located just above the tailbone. It causes inflammation of the spinal bones that in turn cause pain and stiffness. With time, this inflammation spreads to the entire spine and the vertebrae begin fusing together. This can make movement difficult and painful. In severe cases, it can also lead to the development of a hunchback. This disease also affects the other tissues of the body. For example, it can affect other joints and aggravate arthritis or affect organs such as the kidney, heart, lungs, and eyes.

A specific cause has not yet been identified for Ankylosing Spondylitis. However, studies show that genetic factors can be a trigger. In particular, the presence of the HLA-B27 gene increases a person’s risk of developing symptoms pertaining to this condition. However, it is important to note that merely the presence of this gene does not make Ankylosing Spondylitis inevitable. Other genes that are associated with this disease are ARTS1 and IL23R. These genes influence the functioning of the immune system. While it can affect people of all ages, adults are at a higher risk of suffering from this condition.

In many cases, the initial inflammation of the spine is due to a bacterial infection of microbial infection. Though the infection itself may be treated and cured, it may cause the immune system to react and trigger inflammation. Once activated, if the immune system cannot be turned off, this inflammation will continue and can trigger Ankylosing Spondylitis. In each case, the disease presents a unique pattern of progression.

There is presently no cure for this condition, but with an early diagnosis and treatment, the symptoms can be managed and progression can be slowed. This treatment usually takes the form of medication to relieve pain, inflammation and discomfort and physical therapy. Surgery cannot be used to treat Ankylosing Spondylitis but in cases where it has caused severe joint damage, surgery may be advised to replace the damaged joint. If you wish to discuss about any specific problem, you can consult a Rheumatologist.

Whether you are an athlete or a ballet dancer, you will appreciate the importance of having a stable kneecap. Medically known as the patella, the kneecap is a triangular bone that connects the upper thigh to the lower half of the leg. It sits in a groove in the bottom of the femur (thigh bone). When the leg is bent, it stays within the groove. When the leg is extended, it provides support to the quadriceps muscles.

That being the case, a dislocation of the kneecap is a very common injury. Subluxation is a state where there is partial movement of the kneecap out of its position, thereby making the patient’s kneecap unstable. When it completely moves out of its place, it is known as dislocation. Whether you fall on your knees during a sport or have a fall from a bike or get injured during dance or aerobics, it is common to have a dislocated kneecap. Some people are prone to repeated dislocations.

Symptoms:

The initial injury is very painful and there might also be damage to the surrounding structures. Other symptoms include:

1. Buckling of the knee, where your legs cannot support your body weight

2. Sliding of the kneecap to a side

3. Catching of the knee in the groove when trying to move it

4. Pain in the front of the kneecap with any activity

5. Painful while sitting

6. Swelling and/or stiffness of the knee joint

7. Crackling/creaking sound when trying to move the knee joint

8. Inability to straighten the leg

Treatment:

Though these sound scary, the good news is that in 90% of the cases, the knee returns to its position spontaneously. However, putting it back into its place is a simple and safe procedure and can be done by almost any seasoned medical practitioner. The first step is to confirm that the kneecap is indeed dislocated. This can be done by a combination of physical exercise and x-ray. If required, MRI can be used, but it is not required in most cases. Initial treatment would include the following steps in sequence:

1. Immobilizing the knee with splint by keeping the leg in a straightened position.

2. Calling for medical assistance immediately. They can replace the knee back in its position carefully (reduction). An injured kneecap can cause what is known as foot drop by putting pressure on the peroneal nerve. The toes drag on the ground, making it difficult for you to walk.

3. Use ice in the affected area for 15 to 20 minutes, and repeat after three to four hours throughout the day to reduce pain and swelling.

4. Surgical correction may not be required, if there is a damage to the ligament.

5. Flat femur and/or tissue laxity can cause repeated dislocations, where physiotherapy and strengthening exercises are useful. If you wish to discuss about any specific problem, you can consult a physiotherapist.

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:

• Relieve pain

• Help the hip joint work better

• Improve walking and other movements.

Who Should Have Hip Replacement Surgery?

The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. Medications.

These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x-ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.

The Procedure-

Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.

1. An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. The hip muscles are then put in place and the incision is closed.

Post -surgery-

After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.

After care-

It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. If you wish to discuss about any specific problem, you can consult a orthopedist.

People who suffer from arthritis are more likely to experience osteoarthritis symptoms. The intensity of the feeling of knee pain in winter is often linked to barometric pressure. In winter, there is a reduction in the pressure exerted by the air around us. This drop in pressure can cause the tissues around the joints to swell resulting in increased pain. The other possible cause of knee pain in winter can be explained from the influence of heat. Fluid in tissues becomes more viscous during winter. As a result of this increased viscosity, the elasticity of the muscles decreases, resulting in winter aches and pains. 

Some scientists believe that the higher pain intensity in winter is to be more of a psychological thing. Seasonal affective disorder is more during winter, and people suffering from mental depression seem to sense more pain during winter as the weather restricts outdoor activities. Improper intake of food also causes knee pain in winter due to undigested material. Even though winter arthritis is uncomfortable, the following tips help to make the joints work better and make you withstand the season easier.

Tips to Manage Joint Pain in Winters

1. Physical activity in winter can reduce winter aches and pains and enhance overall health benefits. Low impact activities like aerobics, swimming in a heated pool, weight training, and riding a stationary bicycle can reduce stiffness, increase the blood flow, and support the knees. Thus, winter arthritis can be well managed by doing exercises.
2. Diet also plays a vital role. Eating a balanced diet that comprised of low saturated fat, lean proteins, more fiber, and refined carbs helps to improve body functions during the winter. Drinking water throughout the day helps to reduce winter aches and pains. It is essential to consume easily digestible foods like vegetables. Consuming vegetables like carrots and cucumbers that have diuretic properties can help to eliminate waste products from the body.
3. Vitamin D deficiency may worsen osteoarthritis. It is necessary to take a supplement vitamin D or ensure to make your diet is vitamin-D rich. Fish oil is a potent source of omega 3 fatty acids. Increase your intake of milk, a rich source of protein and calcium that help to strengthen the bones. Exposing the body to sunlight help to obtain vitamin D.
4. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can be used to reduce inflammation and pain. Injecting a viscous substance can decrease the friction of the bones and ease the condition.

Home Remedies for Knee Pain in Winters

1. Wrap the inflamed knees with blanched cabbage leaves. This can cool down inflamed knees. Aloe vera also helps to reduce inflammation.
2. Comfrey (symphytum officinale) can act as an anti-inflammatory agent. Create a compress using mashed root or comfrey tea soaked bandages can also be used to reduce inflammation.
3. Applying an ice-pack can help to reduce swelling and alleviate winter aches and pains. While applying ice-pack, ensure to cover the entire knee. Applying a bag of frozen peas to the area also works well. While using ice or heat therapy, make sure to do them carefully as over agressive and over doing it, can cause problems. 
4. Steam therapy also helps to reduce pain in your knees. Soak your knee in a steaming hot water for 15 minutes. Applying hot water bag also can relieve knee pain in winter effectively.
5. Winter aches and pains all over the body can be relieved by administrating massage therapy by a professional.
6. Avoid applying strain or pressure on your knees. Take adequate amount of rest to reduce pain and swelling.

These are basic guidelines to help you. Contact your doctor for further management.

Cartilage is a fine, rubbery elastic tissue that acts as cushion between the bones in the joint spaces. It is a connective tissue and enables the joints to move freely and smoothly. It acts as a shock absorber and reduces the friction between the joints. This cartilage could either be damaged as a result of injury or degeneration as part of normal ageing process. Either of this causes friction during joint movement, causing painful, stiff movements and in some cases, even swelling of the joint spaces.

There is also a covering around the joints known as synovium. When there is a cartilage damage, this synovium is irritated, leading to increased secretion of synovial fluid, which can cause swelling in joints. There is also reduction in the range of motion of the affected joint.

Most commonly affected joints include knees, hips, shoulders, elbows and ankles. Other than degeneration that happens with ageing, cartilage damage is mainly caused by injury or trauma including fall/impact, joint dislocation, infection, ligament tear, meniscus tear, and inflammation (gout, arthritis, etc.)

Read on to know some of the most common causes for cartilage damage and ways to manage it.

Causes:

Age and trauma are the main reasons for cartilage damage.

1. Direct blow: A heavy blow directly to any joint leads to damage (accident, sports injury, etc.).

2. Ageing: With constant wear and tear, joints that are under constant stress are prone for damage.

3. Obesity: This is also a common cause leading to chronic inflammation and breakdown of the joints.

4. Limited mobility: For whatever reasons (including sedentary lifestyle), lack of movement can cause cartilage damage.

Diagnosis:

The presenting symptoms of a person with any affected joint would be pain, discomfort and stiffness with movement. In addition to history and physical examination, MRI and arthroscopy can be used to confirm the diagnosis.

Treatment:

Start with a conservative approach and gradually switch to more advanced treatments. Conservative approach includes a combination of pain killers, steroid injections, and exercise (at a clinic or at home). If these do not work, the following surgical options are available:

1. Debridement: The affected cartilage is smoothened and the loose edges are removed to prevent rubbing and irritation. It is done using a shaver.

2. Marrow Stimulation: Using the marrow cells, more cartilage production is stimulated. Using tiny drills, holes are drilled to form a blood clot, which triggers formation of new cartilage.

3. Mosaicplasty: In areas of localized damage, healthy cartilage from an unaffected area is placed.

4. Autologous Chondrocyte Implantation: Cartilage that is grown in a lab for one to three months are placed into the knee or affected joint to allow for healthy tissue growth. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.