Ankylosing Spondylitis

Ankylosing Spondylitis Disease AS 150610 Final.indd 2 15. 6. 10. 12:16

Understanding what to expect can help you prepare for your transition into treatment. Ankylosing Spondylitis What You Need To Know About Ankylosing Spondylitis This medical guide is designed for educational purposes to help patients understand Ankylosing Spondylitis. Please consult with your doctor on specific questions and details about your symptoms. Disease AS 150610 Final.indd 4 15. 6. 10. 12:16

What You Need To Know About Ankylosing Spondylitis Contents What is Ankylosing Spondylitis? What causes Ankylosing Spondylitis? What are the symptoms of Ankylosing Spondylitis? How does Ankylosing Spondylitis affect the spine? How is Ankylosing Spondylitis diagnosed? How is Ankylosing Spondylitis treated? What are the complications of Ankylosing Spondylitis? Frequently asked questions How can I manage Ankylosing Spondylitis in daily life? Disease AS 150610 Final.indd 7 15. 6. 10. 12:16

What is Ankylosing Spondylitis? 1-3 Disease AS 150610 Final.indd 6 15. 6. 10. 12:16

02 What is Ankylosing Spondylitis? 1-3 03 Ankylosing Spondylitis is a chronic inflammatory rheumatic disease that affects the vertebrae in the spine. It causes inflammation of the spine that leads to back pain, discomfort, and morning stiffness. If spinal inflammation is severe, new bone can form on the spine and cause spinal joints to fuse together. This spinal fusion results in the characteristic hunched-forward posture that greatly reduces range of mobility and flexibility. Affected Area How common is Ankylosing Spondylitis? 4,5 Ankylosing Spondylitis is relatively common, with approximately 0.1-2% of the world s population affected by the disease. Prevalence is highest in people of Northern European descent, while lowest in people of Afro-Caribbean descent. The average incidence for Ankylosing Spondylitis is 23.8 per 10,000. Disease AS 150610 Final.indd 8 15. 6. 10. 12:16

What causes Ankylosing Spondylitis? 6,7 Disease AS 150610 Final.indd 9 15. 6. 10. 12:16

What You Need To Know About Ankylosing Spondylitis What causes Ankylosing Spondylitis? 6,7 Trigger factor Genetic HLA-B27 Infections, environmental factors The exact cause of Ankylosing Spondylitis remains unknown. However, a particular gene known as HLA-B27 is thought to be an important link to the disease. Other genetic or environmental triggers may also play a role in the development of the disease. What exactly is HLA-B27? 6 Human Leukocyte Antigens (HLA) are proteins found on surfaces of white blood cells in your body. They carry out an important role in regulating immune responses by determining harmful foreign agents and leading them to disease-fighting cells that destroy them. HLA-B27, a subtype of HLAs, is known to cause abnormal immune responses, resulting in the immune system attacking healthy cells instead of harmful substances. This kind of disruption in the immune system leads to symptoms of Ankylosing Spondylitis. Disease AS 150610 Final.indd 11 15. 6. 10. 12:16

What are the symptoms of Ankylosing Spondylitis? 8 Disease AS 150610 Final.indd 10 15. 6. 10. 12:16

04 What are the symptoms of Ankylosing Spondylitis? 8 05 Ankylosing Spondylitis can cause pain and stiffness in the following areas: Sacroiliac joints that connect your back and pelvis Vertebrae of the lumbar spine Entheses (junction between tendon, ligament, and bone) of your back or heels Cartilage between the sternum and ribs Hips and shoulder joints Shoulder Sternum Spine (Tendons) (Ligament) Ribs Sacroiliac joint Pelvis (Hips) Heels Disease AS 150610 Final.indd 12 15. 6. 10. 12:16

How does Ankylosing Spondylitis affect the spine? 1,9 Disease AS 150610 Final.indd 13 15. 6. 10. 12:16

What You Need To Know About Ankylosing Spondylitis How does Ankylosing Spondylitis affect the spine? 1,9 Chronic inflammation may cause new bone to form around the spine, leading to spinal fusion and ossification. This results in limited spinal mobility and a forward-stooped posture. Normal posture Advanced Ankylosing Spondylitis Ankylosing SpondylitiS progress Inflammation Fusion Normal Spine Early Ankylosing Spondylitis Advanced Ankylosing Spondylitis Disease AS 150610 Final.indd 15 15. 6. 10. 12:16

How is Ankylosing Spondylitis diagnosed?10 Disease AS 150610 Final.indd 14 15. 6. 10. 12:16

06 How is Ankylosing Spondylitis diagnosed?10 07 A comprehensive medical examination covering medical and family history, blood tests, x-ray, and MRI scans is important in making a diagnosis. Medical History Personal and family medical history is used to assess if you are at a higher risk of developing Ankylosing Spondylitis. Physical Exam Your physician will check for symptoms such as: Chronic pain lasting for more than 3 months. Back pain and stiffness that improve with exercise and worsen with rest. Limited mobility in the spine and ribs. Blood Test Blood samples are tested for HLA-B27 and signs of inflammation. Radiology Test Physical changes in the early stages of Ankylosing Spondylitis may not be clearly visible in x-ray tests. MRI can provide a more detailed image of your spine. Disease AS 150610 Final.indd 16 15. 6. 10. 12:16

How is Ankylosing Spondylitis Treated?11-14 Disease AS 150610 Final.indd 17 15. 6. 10. 12:16

What You Need To Know About Ankylosing Spondylitis How is Ankylosing Spondylitis Treated?11-14 Goal Ankylosing Spondylitis cannot be cured completely. Treatment for Ankylosing Spondylitis aims to relieve symptoms and delay the process of spinal fusion. Medication Biologics Help reduce joint pain, stiffness, and swelling by blocking tumor necrosis factors (TNFs) that trigger inflammation. Anti-TNF agents: infliximab, adalimumab, etanercept, and golimumab. Taken by subcutaneous injection or through an intravenous line. Biosimilars biologic medical products highly similar to previously authorized biological medicines. Non-steroidal anti-inflammatory drugs (NSAIDs) First-line treatment option for Ankylosing Spondylitis. Reduce pain and stiffness of the joints. Most commonly include ibuprofen, indomethacin, and naproxen. High doses may cause side effects in the cardiovascular, gastrointestinal and renal systems. Glucocorticoids Prescribed to relieve more severe symptoms when non-steroidal anti-inflammatory drugs (NSAIDs) are not effective. Include corticosteroid injections (cortisone) and oral corticosteroids (prednisone and prednisolone). Taken for a short period of time to avoid side effects. Disease-modifying anti-rheumatic drugs (DMARDs) Prescribed as an alternative treatment option in severe cases of Ankylosing Spondylitis. Help manage joint symptoms as well as gastrointestinal inflammation. Include sulfasalazine and methotrexate. Disease AS 150610 Final.indd 19 15. 6. 10. 12:16

What are the complications of Ankylosing Spondylitis?15 Disease AS 150610 Final.indd 18 15. 6. 10. 12:16

08 What are the complications of Ankylosing Spondylitis?15 09 While Ankylosing Spondylitis mostly affects the spine, it can cause problems in other parts of the body, such as the eyes, neck, and ribs. Inflammatory affected site: Most common Rare/common Rare Very rare (%, Prevalence) Eyes (40%) Jaw (15%) Neck (75%) Shoulders (30%) Ribs (20%) Rib-spine junction (70%) Lumbosacral (50%) Wrist (5%) Fingers (5%) Sacroiliac (100%) Hips (30%) Knees (20%) Toes (5%) Heels (30%) Disease AS 150610 Final.indd 20 15. 6. 10. 12:16

Frequently Asked Questions Disease AS 150610 Final.indd 21 15. 6. 10. 12:16

What You Need To Know About Ankylosing Spondylitis Frequently Asked Questions Will smoking worsen Ankylosing Spondylitis? 6 A_ Smoking is a major risk factor for Ankylosing Spondylitis, and continuing your smoking habits can result in more joint and spinal damages. Smoking can also further limit your ability to breathe. For treatment to be effective, smoking should be avoided. Can I exercise while diagnosed with Ankylosing Spondylitis? 6 A_ Although Ankylosing Spondylitis results in reduced mobility, regular exercise is important for reducing pain and stiffness. Spinal stretch exercises and breathing exercises can help slow down the progression of Ankylosing Spondylitis. Other exercises that help build a good posture are also recommended. Can Ankylosing Spondylitis be cured? 16 A_ Currently, Ankylosing Spondylitis remains an incurable disease. However, some treatments are successful in relieving symptoms and preventing the progression of the disease. Treatment generally involves various combinations of medication, exercise, lifestyle modifications, and surgery in severe cases. Should I watch my diet? 16 A_ There is no specific diet for patients with Ankylosing Spondylitis. However, a healthy and nutritious diet, along with regular exercise may help reduce pain and swelling of the joints. Disease AS 150610 Final.indd 23 15. 6. 10. 12:16

How can I manage Ankylosing Spondylitis in daily life? 6 Disease AS 150610 Final.indd 22 15. 6. 10. 12:16

10 How can I manage Ankylosing Spondylitis in daily life? 6 11 Maintain good posture and avoid stooping forward Avoid heavy lifting and any physical activity that may cause joint and muscle strain Sleep on a firm bed and on your back to keep a flat sleeping position Apply heat to ease pain and swelling Maintain a balanced diet and reduce stress Communicate with your doctor regularly What You Need To Know About Ankylosing Spondylitis Disease AS 150610 Final.indd 24 15. 6. 10. 12:16

REFERENCES 1. Ankylosing spondylitis. Mayo clinic. Available at http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766 Accessed May 2015. 2. Ankylosing spondylitis: an overview. J Sieper et al,. Ann Rheum Dis. 2002;61:iii8 iii18 3. Ankylosing Spondylitis. Arthritis victoria. Available at http://www.arthritisvic.org.au/ Conditions-and-Symptoms/Ankylosing-Spondylitis Accessed May 2015. 4. Ankylosing Spondylitis. Patient UK. Available at http://www.patient.co.uk/doctor/ankylosing-spondylitis-pro Accessed May 2015. 5. Global prevalence of ankylosing spondylitis. Dean LE et al,. Rheumatology (Oxford). 2014;53:650-7 6. Ankylosing Spondylitis: The Facts. Khan MA. Oxford University Press. 2002. 7. Ankylosing spondylitis. Spondylitis Association of America. Available at http://www.spondylitis.org/about/as.aspx Accessed May 2015. 8. Ankylosing spondylitis_symptoms. Mayo clinic. Available at http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/symptoms/con-20019766 Accessed May 2015. 9. Ankylosing spondylitis. WebMD. Available at http://www.webmd.com/arthritis/ankylosing-spondylitis Accessed May 2015. 10. Ankylosing spondylitis diagnosis_ SAA. Available at http://www.spondylitis.org/about/as_diag.aspx Accessed May 2015. 11. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Braun J et al,. Ann Rheum Dis. 2011;70:896-904 12. Treatment for Ankylosing Spondylitis. Available at http://www.healthline.com/health/ankylosing-spondylitis/treatment#2 Accessed May 2015. 13. Biosimilars. FDA. Available at http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/approvalapplications/therapeuticbiologicapplications/biosimilars/default.htm Accessed May 2015. 14. Medications used to treat ankylosing spondylitis_saa. Available at http://www.spondylitis. org/about/medications.aspx Accessed May 2015. 15. Complications of spondylitis. Available at http://www.spondylitis.org/about/compguy_pop.html Accessed May 2015. 16. Questions and Answers about Ankylosing Spondylitis. NIH. Available at http://www.niams.nih.gov/health_info/ankylosing_spondylitis/ Accessed May 2015. HCREM-05 PB-0515 Disease AS 150610 Final.indd 3 15. 6. 10. 12:16