Ankylosing spondylitis can be divided into different stages and courses:

1. Early stage: Inflammation of the sacroiliac joints (sacroiliitis) with back pain and morning stiffness.
2. Advanced stage: Ossification of the spine with movement restrictions and pain throughout the back area.
3. Extraspinal manifestations: Involvement of peripheral joints or tendon attachments, e.g., in the hip, knee, or Achilles tendon.
4. Systemic manifestations: Inflammations outside the musculoskeletal system, such as uveitis, psoriasis, or inflammatory bowel diseases. 

The exact causes of ankylosing spondylitis are not fully understood, but genetic and immunological factors play a central role:

• Genetic predisposition:
  • The HLA-B27 gene is detectable in about 90% of those affected and increases the risk of the disease.
• Autoimmune reactions:
  • A misguided immune response leads to chronic inflammation of the spine and joints.
• Environmental factors:
  • Infections could act as triggers for the disease by activating the immune system.
• Mechanical stress:
  • Chronic overload or poor posture can promote the course of the disease.

The symptoms of ankylosing spondylitis are diverse and depend on the stage of the disease:

- **Back pain:** Pain in the lower back or in the sacroiliac joints, which occurs especially at night and in the morning.

- **Morning stiffness:** Stiffness of the spine that improves with movement.

- **Movement restrictions:** Progressive stiffening of the spine that limits mobility.

- **Pain at tendon attachments:** Discomfort at the Achilles tendon, plantar tendon, or rib-vertebra junction.

- **Systemic symptoms:** Fatigue, fever, or weight loss during active inflammation.

- **Eye inflammation (uveitis):** A common comorbidity with eye redness, pain, and light sensitivity.

The diagnosis is made through a combination of medical history, physical examination, and imaging techniques:

• Medical history:
  • The doctor inquires about back pain, morning stiffness, and family history.
• Physical examination:
  • Tests such as the Schober test or the Ott test to check the mobility of the spine.
• Laboratory tests:
  • Detection of the HLA-B27 gene and elevated inflammation markers (CRP, ESR).
• Imaging techniques:
  • X-ray: Visualization of ossifications and joint changes.
  • MRI: Early detection of inflammation in the sacroiliac joints and the spine.

Conservative Therapy

Ankylosing spondylitis is usually treated non-surgically to alleviate symptoms and maintain mobility:

• Medication Therapy:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief and anti-inflammation.
  • Biologics (TNF-α or IL-17 inhibitors) for severe or treatment-resistant cases.
• Physiotherapy:
  • Special exercises to improve mobility and strengthen the back muscles.
• Occupational Therapy:
  • Adaptation of daily aids to facilitate movement processes.
• Pain Therapy:
  • Heat or cold applications to reduce discomfort.

Surgical Therapy

In severe cases or with pronounced stiffening, surgical intervention may be necessary:

• Spinal Surgery:
  • Correction of misalignments or stiffening of the spine.
• Joint Replacement:
  • Implantation of hip or knee prostheses in cases of severe joint involvement.

To prevent or delay the progression of the disease, the following measures are recommended:

1. Regular exercise: Promote spinal mobility through targeted exercises and sports such as swimming or yoga.
2. Ergonomic posture: Avoid poor posture by maintaining optimal sitting and standing positions.
3. Weight reduction: Relieve the spine by maintaining a healthy body weight.
4. Smoking cessation: Avoid nicotine, which worsens the oxygen supply to the bones.
5. Early treatment: Consult a rheumatologist at the first signs of back pain or stiffness.