Ankylosing spondylitis is a condition commonly known as "hunchback ." It is a rheumatic disease characterized by inflammation and gradual fusion of bones in the spine. Ankylosing spondylitis typically begins in the sacroiliac joints (the joints between the pelvis and spine) and gradually affects the spine. Furthermore, if the disease also affects the ribs, deep breathing can become difficult.

Ankylosing spondylitis is more common in men than in women. Signs and symptoms usually appear in early adulthood. The inflammation usually begins in the eyes, but it can also occur in other parts of the body.

Unfortunately, there is no definitive or permanent cure for ankylosing spondylitis. However, several treatment options are available to relieve symptoms and slow the progression of the disease. Treatment generally aims to reduce symptoms, manage pain, and increase mobility.

Causes of Ankylosing Spondylitis

The exact cause of ankylosing spondylitis is unknown. However, genetic predisposition and environmental factors are thought to play a role in the disease's development.

• Genetic predisposition: Genetic factors play a significant role in the development of ankylosing spondylitis. Most individuals with ankylosing spondylitis carry a genetic trait called HLA-B27. However, not everyone with HLA-B27 develops ankylosing spondylitis. Therefore, other genetic and environmental factors are thought to influence the development of the disease.
• Inflammation: Ankylosing spondylitis is associated with inflammation. Inflammation is a normal immune system response to a foreign substance or infection. In individuals with ankylosing spondylitis, the immune system mistakenly attacks its own tissues, causing inflammation in the spine. Over time, this inflammatory process can lead to the fusion and fusing of the bones in the spine.
• Environmental factors: There is some evidence that environmental factors play a role in the development of ankylosing spondylitis. Smoking is a factor that may increase the risk of ankylosing spondylitis. It is also thought that environmental triggers, such as certain infections (e.g., intestinal infections) or trauma, may play a role in the development of the disease.

The exact mechanism underlying the development of ankylosing spondylitis is still being investigated. A combination of genetic predisposition and environmental factors may contribute to the development of the disease. However, the likelihood of an individual developing ankylosing spondylitis cannot be predicted accurately, and the disease can progress differently in each individual.

How Does Ankylosing Spondylitis (Humpback) Begin?

Ankylosing spondylitis usually has a distinct onset. The first symptoms typically begin with pain and stiffness in the sacroiliac joints (the joints between the pelvis and spine). These symptoms typically develop gradually and worsen over time. The symptoms and onset of ankylosing spondylitis can vary from person to person, but the most common symptoms include:

• Low back pain: The first symptom is usually low back pain. It can be aching and stiff, especially in the morning and after prolonged inactivity. This pain usually lasts for more than three months and can be relieved with exercise.
• Morning stiffness: In the morning or after sitting for a long time, the body may feel stiff and movement may become difficult. The feeling of stiffness usually subsides after moving for a long time in the morning.
• Limited spinal movement: As ankylosing spondylitis progresses, limited movement in the spine may occur. Initially limited to the lumbar region, this limitation can spread to the neck and upper back over time.
• Spinal deformities: As ankylosing spondylitis progresses, a curvature of the spine may develop. This can cause the head to be held forward and reduce flexibility of the spine.
• Joint pain and swelling: Ankylosing spondylitis can also affect other joints. Pain and swelling can occur, particularly in the hips, knees, and shoulders.

These symptoms may appear in the early stages of ankylosing spondylitis and worsen over time. However, symptoms can vary from person to person. If you experience one or more of these symptoms, it's important to consult a doctor and have the necessary evaluation.

How Is Ankylosing Spondylitis Diagnosed?

• Medical history and physical exam: Your doctor will evaluate your symptoms and medical history (e.g., pain, stiffness, onset of symptoms, family history of similar cases). They will also check for physical findings, such as limited movement in the spine and other joints, stiffness, and signs of inflammation.
• Imaging tests: Imaging tests such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans are used to evaluate inflammation and fusion in the spine. These tests can reveal characteristic findings of ankylosing spondylitis, such as fused vertebrae, inflammation of the sacroiliac joints, and spinal deformities.
• Laboratory tests: Blood tests can be used to measure inflammatory markers (e.g., sedimentation rate, C-reactive protein) and to detect the presence of the HLA-B27 gene. However, the HLA-B27 gene alone is not sufficient to diagnose ankylosing spondylitis because some HLA-B27-positive individuals may not develop the disease.
• Clinical assessment: Clinical assessment tools such as the Ankylosing Spondylitis Disease Activity Score (ASDAS) can be used to assess the activity of ankylosing spondylitis and changes in disease activity.

The diagnostic process is typically led by a rheumatologist. It's important to make an accurate diagnosis to rule out other medical conditions and distinguish ankylosing spondylitis from other similar conditions. Diagnosis will be based on your symptoms and test results. If ankylosing spondylitis is diagnosed, your doctor will recommend appropriate treatment options.

How Is Ankylosing Spondylitis Treated?

Treating ankylosing spondylitis often requires a multidisciplinary approach to relieve symptoms, slow disease progression, and improve quality of life. Common methods used in the treatment of ankylosing spondylitis include:

• Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain and inflammation. Along with NSAIDs, corticosteroids or other immune-suppressant medications may also help control more severe symptoms.
• Physical therapy: Physiotherapy plays an important role in the treatment of ankylosing spondylitis. Physiotherapists work to improve patients' conditions through exercise programs, posture correction, exercises to increase spinal mobility, and stretching techniques.
• Exercise programs: Regular exercise is crucial for individuals with ankylosing spondylitis. It helps maintain spinal flexibility and mobility. A program consisting of a variety of exercises, including stretching, strengthening, and aerobic exercises, supports patients' health.
• Hot and cold therapy: Hot applications (hot shower, hot towel) and cold compresses can be used to relieve pain and stiffness.
• Surgical intervention: This is a rarely used option and is only considered in cases such as spinal deformities or serious hip and knee problems.
• Psychological support: Ankylosing spondylitis is a chronic disease that can negatively impact quality of life. Psychological support can be important by strengthening patients' coping skills and providing emotional support.

The treatment plan is individualized based on the severity of the patient's symptoms, disease progression, and individual needs. It is important for patients to have regular checkups with their doctor to monitor the effectiveness of the treatment plan. By controlling symptoms, treatment can help patients maintain their daily activities and mobility.

What are the possible complications of ankylosing spondylitis?

Ankylosing spondylitis is a progressive disease characterized by inflammation and deformity of the spine and other joints. Progressive ankylosing spondylitis can lead to various complications. Common complications that can occur with ankylosing spondylitis include:

• Spinal deformities: As ankylosing spondylitis progresses, a hunchback (curvature) may develop in the spine. This can cause the head to be tilted forward and reduce flexibility in the spine. Hunchbacks can lead to limited mobility, back pain, and breathing problems.
• Rib cage stiffness: Ankylosing spondylitis can cause inflammation of the ribs and rib cage. This can limit rib cage mobility and make it difficult to breathe deeply.
• Sacroiliitis: Inflammation in the sacroiliac joints may be an early sign of ankylosing spondylitis. Prolonged and recurring inflammation can cause the sacroiliac joints to fuse and harden.
• Joint damage: Ankylosing spondylitis can also affect other joints, particularly the hips, knees, shoulders, and ankles. Long-term inflammation can lead to joint damage and loss of joint function.
• Eye problems: Some people with ankylosing spondylitis can develop inflammation and infections of the eyes. Common eye problems include inflammation of the iris (the part that determines eye color) (iridocyclitis) or uveitis (inflammation of the inner layers of the eye) .
• Heart problems: Some people with ankylosing spondylitis develop inflammation of the heart valves and major arteries. This can lead to narrowing or leaking of the heart valves and heart rhythm disturbances.

These complications do not occur in the same way in every individual with ankylosing spondylitis. The risk of complications may vary depending on disease severity, early response to treatment, genetics, and other factors. However, complications can be prevented or managed with regular follow-up, appropriate treatment, and lifestyle management.

Lifestyle Changes and Home Care for Ankylosing Spondylitis

For individuals with ankylosing spondylitis, lifestyle changes and home care methods can help manage symptoms and improve quality of life. Some recommended lifestyle changes and home care methods for ankylosing spondylitis include:

• Regular exercise: Exercise is important for individuals with ankylosing spondylitis. Regular stretching and strengthening exercises, performed under the guidance of a physical therapist, can help maintain spinal flexibility. Additionally, low-impact aerobic exercise (such as swimming or cycling) can support overall health.
• Correct posture: Maintaining correct posture can reduce stress on the spine. Maintaining an upright posture and maintaining the natural curve of the spine is especially important when sitting and walking.
• Heat and cold applications: Warm compresses or hot showers can relieve muscle stiffness and pain. Cold compresses can reduce swelling in inflamed areas. It's important to consult your doctor before using heat and cold applications.
• Stress management: Stress can trigger or worsen symptoms of ankylosing spondylitis. Stress management techniques, such as relaxation exercises, breathing techniques, and meditation, can help reduce stress.
• Supportive equipment: Supportive equipment such as special pillows, bed and chair arrangements can alleviate spinal and joint discomfort.
• Balanced diet: A healthy, balanced diet can help maintain overall health. Anti-inflammatory foods (such as fruits, vegetables, and fish) are recommended.
• Good sleep patterns: Sleep quality can affect ankylosing spondylitis symptoms. Creating a comfortable sleep environment, paying attention to sleep patterns, and optimizing sleep posture are important.
• Social support: Social support is important for coping with ankylosing spondylitis. Staying connected with family, friends, and support groups can provide emotional support and help you share your experiences.

These measures can help relieve symptoms of ankylosing spondylitis and improve quality of life. However, each person's needs may vary, so it's important to develop an individualized plan with your doctor.