Ankylosing spondylitis is a disease in which repeated inflammation occurs in the spinal joints, eventually causing the back to curve and stiffen. It usually occurs in young male patients, so it is also called young man’s disease. So, is the chance of ankylosing spondylitis occurring in women less likely? At all. In fact, nearly 30% of all ankylosing spondylitis patients are women, and that number continues to increase. Let’s learn more about the characteristics and treatment of ankylosing spondylitis in women with Professor Sang-Hoon Lee from the Department of Arthritis and Rheumatology at Gangdong Kyunghee University Hospital.
Ankylosing spondylitis, chronic inflammatory disease, joint deformation due to repeated inflammation
Ankylosing spondylitis is a chronic disease that causes inflammation of the joints. The joints repeatedly become inflamed and weakened, causing the joints to deform. When the joints become stiff, movements become slow and eventually the entire spine becomes stiff and the back bends. The exact cause of the disease has not yet been identified. However, it is known to be related to the “HLA-B27” gene. Additionally, infections, trauma and stress can also have an effect.
It is more common among young people, but some women also occur.
Ankylosing spondylitis is known to occur frequently in young people and is also called youth disease. However, it also occurs quite often in women. According to data from the Health Insurance Review and Evaluation Service, patients who went to hospital with ankylosing spondylitis in 2022 (disease code M45 ankylosing spondylitis) showed that 14,400, or 27%, of the total 52,616 patients were patients female. This means that just because you are a woman, you cannot be safe from ankylosing spondylitis.
It begins with pain in both hip bones and, as it gets worse, progresses to chest pain.
Ankylosing spondylitis usually begins with an inflammation of the hip joint, so at first both hip bones may hurt alternately. As the disease progresses and invades the thoracic spine, even a slight cough causes chest pain, and pain is felt when pressed with the hand. Stiffness and pain are severe in the morning and decrease with activity throughout the day. The pain worsens during the night and in many cases one wakes up from sleep due to the pain. If left without proper treatment during this period, your joints may gradually harden and your back may bend. Once stiff joints fail to recover, early treatment is important.
Women experience more initial pain, but it rarely progresses to severe pain.
Women also have no different symptoms. However, it is known that severe cases accompanied by spinal stiffness are fewer than in men. The initial pain affecting the sacroiliac joints is more intense than in men, so much so that some women are unable to walk and end up in the emergency room. However, symptoms usually subside over time, but in women, in severe cases, the entire spine can stiffen and cause disability.
Pregnancy and childbirth are also possible with ankylosing spondylitis
The biggest concern for female patients is pregnancy and childbirth. I worry a lot about whether I will be able to get pregnant and give birth and whether my disease will get worse if I get pregnant. Some studies have reported that there are risks to childbirth, such as premature birth or low birth weight, but fundamentally ankylosing spondylitis is a disease that allows for a healthy pregnancy and birth.
Even during pregnancy the disease can be treated with drugs and childbirth is also possible. Even if the disease progresses and the sacroiliac joint, which is the joint between the sacrum and the left and right iliac bones of the pelvis, becomes stiff, there are no problems with natural childbirth. Just as a patient without disease may not be able to have a natural birth depending on the situation, one can decide between a natural birth or a cesarean section depending on the situation through regular pre-birth checkups.
Additionally, pregnancy and childbirth do not make ankylosing spondylitis worse. According to a study titled “The Impact of Pregnancy on Radiological Progression of Ankylosing Spondylitis” published in 2022 by Professor Lee Sang-hoon of the Department of Arthritis and Rheumatology of Kangdong Kyunghee University Hospital, pregnancy and childbirth did not cause the progression of ankylosing spondylitis spondylitis disease. In his research, Professor Lee used CT to confirm whether bone deformation, or bone stiffness, of the sacroiliac joint was progressing further, regardless of symptoms. As a result of the study, no difference in bone deformation was found before and after pregnancy and childbirth.
If diagnosed early, it can be controlled with medications and physical therapy.
If ankylosing spondylitis is diagnosed early, the progression of spinal stiffness can be prevented with a combination of drug treatment and physical therapy, which rarely interferes with daily life. The treatment of female patients is no different. Depending on the patient’s condition, drug treatment uses nonsteroidal anti-inflammatory drugs, antirheumatic drugs, as well as TNF blockers, IL-17 blockers and JAK blockers. Physical therapy is a rehabilitation treatment that improves joint flexibility and strength. When combining drug treatment and physical therapy, only 10% of patients progress to stiffness. However, if the diagnosis is missed in the early stages, if the thoracic spine is involved, and spinal stiffness progresses to a certain extent, the treatment effect cannot be optimistic.
There are restrictions on medications during pregnancy, but treatment is possible.
During pregnancy there may be many restrictions on drug treatment. However, drugs given for ankylosing spondylitis are limited to class B during pregnancy and can be treated depending on the situation as they are among the drugs that can be given if medically necessary. By regularly examining the levels and symptoms of inflammation and administering medications accordingly, it is possible to sufficiently maintain the pregnancy and give birth.
Active treatment, constant exercise, a regular lifestyle and stress control are important.
Since inflammation is a disease that occurs spontaneously in the attachment area of the tendon around the joint, the basic treatment is to suppress this inflammation with drug treatment. You can think of it as putting out a fire with a fire extinguisher and preventing tissue damage. Even if the fire is put out, the residual fire remains, so it is very important to conduct regular blood tests and imaging tests to see if it recurs or progresses. Subsequently, once the inflammation passes, the tissues join together and harden, so constant exercise is very important. The main exercise is stretching to maintain the range of motion of the affected joint. To avoid further deterioration, regular living and stress control are also very important.
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