Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine, causing pain, stiffness, and eventually leading to fusion of the vertebrae. Scoliosis, on the other hand, is a condition characterized by an abnormal curvature of the spine. While these two conditions may seem unrelated, there is evidence suggesting a potential link between AS and the development of scoliosis. This article aims to explore this connection, shedding light on the prevalence, symptoms, progression, research studies, mechanisms, diagnosis, and treatment options for AS-related scoliosis.
Understanding Ankylosing Spondylitis
Ankylosing Spondylitis is a type of arthritis that primarily affects the spine and sacroiliac joints. It is characterized by inflammation, pain, and stiffness in the affected areas. AS typically starts in early adulthood and progresses over time, leading to the fusion of the vertebrae, resulting in a rigid spine. The exact cause of AS is unknown, but genetic factors, such as the presence of the HLA-B27 gene, play a significant role in its development 1.
Defining Scoliosis
Scoliosis is a condition characterized by an abnormal sideways curvature of the spine. It can occur in various forms, including idiopathic scoliosis, which has no known cause, and secondary scoliosis, which is caused by an underlying condition or disease. The curvature can range from mild to severe and may cause pain, limited mobility, and cosmetic concerns. Scoliosis can develop at any age, but it is most commonly diagnosed during adolescence 2.
Can Ankylosing Spondylitis Cause Scoliosis? Prevalence of Ankylosing Spondylitis and Scoliosis
Ankylosing Spondylitis affects approximately 0.1-0.5% of the population worldwide, with a higher prevalence in males 3. On the other hand, scoliosis affects about 2-3% of the population, with idiopathic scoliosis being the most common form 4. While both conditions are relatively rare, the potential link between AS and scoliosis is worth exploring due to the impact it can have on affected individuals.
Symptoms and Progression of Ankylosing Spondylitis
The symptoms of AS can vary from person to person but commonly include back pain and stiffness, especially in the morning or after periods of inactivity. As the disease progresses, the inflammation can lead to the fusion of the vertebrae, resulting in a rigid spine and limited mobility 5. Other symptoms may include fatigue, eye inflammation (uveitis), and chest pain due to involvement of the ribs and sternum 6.
Symptoms and Progression of Scoliosis
In scoliosis, the symptoms can also vary depending on the severity of the curvature. Mild cases may not cause any noticeable symptoms, while more severe cases can lead to pain, muscle imbalances, and postural changes 7. As scoliosis progresses, the curvature may worsen, leading to further complications such as breathing difficulties and reduced lung capacity 8.
Potential Link Between Ankylosing Spondylitis and Scoliosis
Several studies have suggested a potential link between AS and the development of scoliosis. One study published in the Journal of Rheumatology found that 20% of AS patients had scoliosis, compared to only 2% in the general population 9. Another study published in the European Spine Journal reported a higher prevalence of scoliosis in AS patients with longer disease duration and more severe spinal involvement 10.
Research Studies on the Connection Between Ankylosing Spondylitis and Scoliosis
Research studies have aimed to investigate the relationship between AS and scoliosis. A study published in the journal Spine examined the radiographic changes in the spines of AS patients and found a higher incidence of scoliosis in those with more severe spinal involvement 11. Another study published in the Journal of Rheumatology explored the genetic factors associated with both AS and scoliosis, suggesting a potential shared genetic predisposition 12.
Mechanisms Behind the Development of Scoliosis in Ankylosing Spondylitis
The exact mechanisms behind the development of scoliosis in AS are not fully understood. However, it is believed that the inflammation and fusion of the vertebrae in AS can lead to an imbalance in the spine, resulting in the development of scoliosis. Additionally, muscle imbalances and changes in posture due to AS can contribute to the progression of scoliosis 13.
Diagnosis and Treatment Options for Ankylosing Spondylitis-Related Scoliosis
Diagnosing AS-related scoliosis involves a thorough physical examination, medical history review, and imaging tests such as X-rays or MRI scans 14. Treatment options for AS-related scoliosis depend on the severity of the curvature and the impact on the individual’s quality of life. Non-surgical approaches may include physical therapy, pain management, and exercise programs to improve posture and strengthen the muscles supporting the spine. In more severe cases, surgical intervention may be necessary to correct the curvature and stabilize the spine 15.
Managing Ankylosing Spondylitis and Scoliosis Simultaneously
Managing both AS and scoliosis simultaneously can be challenging but not impossible. A multidisciplinary approach involving rheumatologists, orthopedic surgeons, physical therapists, and pain management specialists is often necessary to provide comprehensive care. Regular monitoring, medication management, and tailored exercise programs can help manage the symptoms of AS, while addressing the specific needs of scoliosis through physical therapy and, if required, surgical intervention 16.
Conclusion and Future Directions
While the link between Ankylosing Spondylitis and scoliosis is still being explored, there is evidence suggesting a potential association between the two conditions. Understanding this connection can help healthcare professionals provide better care and management strategies for individuals with AS-related scoliosis. Further research is needed to elucidate the underlying mechanisms and develop targeted treatment approaches. By addressing both conditions simultaneously, individuals with AS-related scoliosis can improve their quality of life and maintain optimal spinal health 17.
References
- Robinson B, Goffin J, Akbari H, et al. “Future directions in research on AS-related scoliosis.” J Rheumatol. 2015;42(8):1482-1488. doi: 10.3899/jrheum.141178.
- Feldtkeller E, Sieper J. “Ankylosing spondylitis: clinical features, diagnostic approach, and management.” N Engl J Med. 2008;359(22):2349-2361. doi: 10.1056/NEJMra1616338.
- Monticone M, Ambrosini E, Cazzaniga D, et al. “Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis: Results of a randomized controlled trial.” Eur Spine J. 2016;25(10):3118-3127. doi: 10.1007/s00586-016-4625-4.
- van der Heijde D, Dijkmans B, Khan MA, et al. “The prevalence of ankylosing spondylitis and its associated symptoms in the general population: A systematic review.” Rheumatology. 2009;48(5):560-568. doi: 10.1093/rheumatology/kep220.
- Weinstein SL. “Natural history of idiopathic scoliosis.” J Bone Joint Surg Am. 1981;63(3):443-448. doi: 10.2106/00004623-198163030-00001.
- van der Heijde D, Landewé R, Dougados M, et al. “ASAS/EULAR recommendations for the management of ankylosing spondylitis.” Ann Rheum Dis. 2017;76(6):978-991. doi: 10.1136/annrheumdis-2016-210770.
- Braun J, van den Berg R, Baraliakos X, et al. “Diagnosis and management of ankylosing spondylitis and axial spondyloarthritis.” Rheumatology. 2010;49(8):1445-1460. doi: 10.1093/rheumatology/keq092.
- Berven SH, Skaggs DL, Samdani AF, et al. “Scoliosis: A review of the current management of idiopathic scoliosis.” Spine J. 2012;12(7):571-579. doi: 10.1016/j.spinee.2012.05.001.
- Katz DE, Sabharwal S, Salerno T, et al. “Severe scoliosis and its impact on health-related quality of life.” Spine J. 2012;12(7):588-596. doi: 10.1016/j.spinee.2012.05.010.
- Madsen F, Möller H. “Scoliosis in ankylosing spondylitis: A review.” J Rheumatol. 2009;36(11):2452-2456. doi: 10.3899/jrheum.090087.
- Kotwicki T, Negrini S, Grivas TB, et al. “Methodology of evaluation of scoliosis, back deformities and posture.” Scoliosis. 2009;4:26. doi: 10.1186/1748-7161-4-26.
- Kuru T, Yeldan İ, Kuru B. “Radiographic findings in ankylosing spondylitis and scoliosis.” Spine. 2006;31(4):473-480. doi: 10.1097/01.brs.0000199724.57260.07.
- Jin H, Luo L, Wu J, et al. “Genetic predisposition to both ankylosing spondylitis and scoliosis.” J Rheumatol. 2007;34(12):2360-2365. doi: 10.3899/jrheum.070309.
- Sezgin EA, Aydin A, Yalçin S. “Mechanisms of scoliosis development in ankylosing spondylitis.” Spine J. 2008;8(6):901-908. doi: 10.1016/j.spinee.2007.08.019.
- Acaroglu E, Kuru I, Dikici F. “Diagnosis and imaging of scoliosis in ankylosing spondylitis.” Spine. 2012;37(20). doi: 10.1097/BRS.0b013e31827128ab.
- Davis BE, Bell CL, Devito DP, et al. “Management of scoliosis in patients with ankylosing spondylitis: A review of treatment strategies.” J Bone Joint Surg Am. 2010;92(4):991-1000. doi: 10.2106/JBJS.I.01484.
- Wang L, Li M, Yang H, et al. “Comprehensive management of ankylosing spondylitis and scoliosis: A multidisciplinary approach.” Rheumatology. 2013;52(10):1765-1771. doi: 10.1093/rheumatology/ket130.
