Ankylosing spondylitis: When the joints heal together

Last updated 24/02/2024 by The pain clinics - Interdisciplinary Health

Ankylosing spondylitis: When the joints heal together

Ankylosing spondylitis, also known as ankylosing spondylitis, is a chronic rheumatic autoimmune diagnosis that affects the vertebrae, pelvic joints, larger joints (including knees and hips) and tendon attachments. Unfortunately, there is no cure for Bekhterev's.

Ankylosing spondylitis is thus a form of arthritis that causes inflammation in the joints and ligaments of the spine and pelvis (sacroilitis).¹ In addition to this, more peripheral joints such as knees, ankles and hips can also be affected. But it is more rare. Normal joint function means good range of motion and being able to move freely. The chronic inflammation in the joints and ligaments of the spine leads to stiffness and reduced mobility. In severe cases, this can cause the vertebrae to fuse together - in such cases you are left with a completely stiff back. But such cases are fortunately very rare these days.

Chronic inflammation of the joints can lead to fused joints

(Figure 1: Illustration of how Ankylosing spondylitis can lead to fused vertebrae)

In the example above (figure 1) you see an illustration of how inflammation in the end plates of the vertebrae and ligaments can lead to gradual calcification and bone formation. We would like to emphasize that the majority of people with Bekhterev's have mild to moderate symptoms. Early diagnosis and more modern treatment methods make it possible to slow down the negative development. The majority of people with Bekhterev's have positive results for HLA-B27 in blood tests.

Tips: Exercise with pilates band (elastic band) can be an excellent form of exercise for people with Bekhterev's. Towards the end of the article shows chiropractor Alexander Andorff also produced a video with recommended back exercises for this patient group.

- There is no cure, but the diagnosis can be kept in check

There is thus no cure, but there are a number of treatment modalities that help control and alleviate the symptoms. Recommended treatment may include mobility exercises, strength training, physical therapy for muscles and joints to improve mobility and posture, as well as drug therapy to reduce inflammation and slow progression. The vast majority of people with Bekhterev's can live good and fulfilling lives.

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

Symptoms of Ankylosing Spondylitis (Ankylosing Spondylitis)

Many people with ankylosing spondylitis experience mild to moderate episodes of back pain and stiffness. Others may experience more significant pain with associated stiffness in the spine and pelvis. It is also important to mention that the diagnosis can lead to the development of eye disease (uveitis), skin disease (psoriasis) or intestinal disease (irritable bowel syndrome).

Joint pain and stiffness

The most common symptom of ankylosing spondylitis is pain and stiffness in the lower back and pelvis. As the rheumatic diagnosis develops, the symptoms will affect larger parts of the spine and body. Characteristically speaking, the pain and stiffness are worst after longer periods of rest and inactivity – for example in the morning and after prolonged sitting. Movement and exercise usually provide pain relief and functional improvement.

May vary from person to person

It is important to state that there are both mild and severe versions of ankylosing spondylitis. Some people have mild periods of pain versus others who have significant, constant pain. Regardless of this, people with the diagnosis may experience worsening in so-called "flare-up periods". So, for example, periods when the inflammation is more active.

Other symptoms

In addition to the stiffness and pain in the back, pelvis and hips - are there more symptoms that you should be aware of. These include:

• Pain, stiffness and inflammation in the ribs, shoulders, knees or feet

• Pelvic joint pain

• Sacroilitis (pelvic arthritis)

• Night pain (due to lack of movement)

• Difficulty taking a full breath in (if the joints of the ribs are affected)

• Vision problems and eye pain (uveitis)

• Fatigue and exhaustion (due to chronic inflammation)

• Lack of appetite and associated weight loss

• Skin rash (possible psoriasis)

• Abdominal pain and irritable bowel

In the next part of the article, we take a closer look at the cause of Bekhterev's disease - we warn in advance that it will be technical (but interesting).

Theory: The cause of Bekhterev's disease

(Figure 2: Possible pathophysiological cause of Bekhterev's | Source: Creative Commons / PubMed)

Before, and until recently, it has long been said that scientists know nothing about the cause of Bekhterev's disease. Well, that's not entirely true. Firstly, we know that research has found concrete evidence that Bekhterev's is an autoimmune diagnosis - meaning that the body's own immune system is behind the chronic inflammation. As seen by increased amounts of T cells.²

The pathophysiology behind Bekhterev's (Ankylosing spondylitis)

Figure 2 above is a demonstration of the possible pathological role of HLA-B27 in ankylosing spondylitis. On the far left you see a cell and the lines indicate which cell structures we are talking about. But you don't have to be 100% committed to that. Briefly, the following happens:

- HLA-B27 plays a central role 

HLA-B27 provides arthritogenic peptides to CD8+ T lymphocyte cells, which in turn initiate the autoimmune process - and thus trigger ankylosing spondylitis. In addition to this, a number of abnormal reactions occur in the cell membrane which result in significant stress reactions on what we call the endoplasmic reticulum (ER). In other words, a cell organelle that consists of membranes - and where the majority of the cell's biochemical processes take place.¹ If you wish, you can also read even more details about this complicated process via the link to the research study.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

Modern and holistic treatment of Ankylosing spondylitis

We can divide modern treatment and rehabilitation of Bekhterev's into three key points:

1. Stimulate mobility and function

2. Strengthen joints and muscles

3. Reduce inflammation

For patients with Bekhterev's, movement is one of the most important things. We know that inactivity and prolonged sitting lead to increased stiffness, more pain and inflammatory reactions. This is precisely why it is so important that people with this diagnosis have good discipline when it comes to daily mobility exercises and follow-up with a physical therapist (such as a physiotherapist or chiropractor). We also recommend fixed intervals with follow-up for joint mobilization and traction treatment (pulling the joints apart) - to maintain joint mobility in a good way. Meta-analyses, the strongest form of research, have also shown that follow-up with a therapist is more effective than doing everything on your own.³ An anti-inflammatory diet can also play a central role.

Good tip: Back stretching board (link opens in a new browser window)

For patients with Bekhterev's, where the main problem is actually extensive stiffness in the back, we cannot escape a recommendation for the use of back stretch board.  This is therefore an in-house measure that stretches and stretches the vertebrae - and pulls them apart. For many people with a very stiff back, many will feel a fairly clear stretching sensation in the first few weeks of using the back stretcher. But eventually it will work out - and the stretching will no longer feel as intense, which will also be a clear sign that it is working. Press the image or here to read more about how it works.

VIDEO: Exercises against Ankylosing spondylitis

In the video above, chiropractor Alexander Andorff v/ Vondtklinikkene avd Lambertseter shows four recommended exercises for patients with Bekhterev's. These are exercises that can be done daily to stretch and maintain better movement in the lower back and pelvis.

«Summary: As with all diagnoses and illnesses, one of the most important things is to take it all seriously. Contact a physical therapist and make sure that you have a good rehabilitation program with the right exercises to deal with, and that you also occasionally get help with joint mobilization and muscular work."

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Our clinicians and clinic departments always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Viken (Raw wood og Eidsvoll Sound).

Sources and research

1. Zhu et al, 2019. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019 Aug 5;7:22. [PubMed]

2. Mauro et al, 2021. Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol. 2021 Jul;17(7):387-404.

3. Gravaldi et al, 2022. Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022 Jan 10;10(1):132.

Article: Ankylosing spondylitis – when the joints heal together

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about Ankylosing spondylitis

1. How can one get a better quality of life with Bekhterev's?

One of the most important things is an early examination to assess function and make a diagnosis. In the case of proven Bekhterev's, regular movement, rehabilitation exercises and physical treatment (for both muscles and joints) will play central roles in maintaining good mobility and functionality. Studies have shown that going regularly to a physical therapist for follow-up in relation to training and rehabilitation has the best effect.³