How to Prevent Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine, causing pain and stiffness in the lower back. People with AS may also experience pain in their neck, shoulders, hips, and heels.

There is no known way to prevent AS, but early diagnosis and treatment can help prevent or slow disease progression. Maintaining a healthy lifestyle, such as getting regular exercise and eating a balanced diet, can also help prevent joint damage and reduce the risk of disease complications. 

Who Is Most at Risk?

Ankylosing spondylitis can affect anyone, but certain people are at a higher risk, including:

• Age: For most people with AS, symptoms begin before age 45. In some rare cases, children and older adults can also develop the condition. 
• Ethnicity: White people, especially those of northern European descent, have a higher chance of developing AS than other ethnicities. 
• Family history: People with a family history of AS are more likely to develop the disease.
• Medical history: People with other autoimmune disorders, such as inflammatory bowel disease (IBD) or psoriasis, are more likely to get AS.  

In the past, experts believed that AS was more prevalent in men than women. New research, however, shows that the cases of AS among men and women are about equal.

Genetics 

Ankylosing spondylitis has a strong genetic component, meaning that if you have a parent or sibling with the condition, you have a higher chance of developing AS yourself.

Certain inherited genes, such as the HLA-B27 gene, may raise the likelihood of developing the condition. More than 90% of white people with AS have the HLA-B27 gene, but the gene is less common in people of other races with AS. This may explain why AS is more common in white people.

Having specific gene mutations is also associated with the way your immune system functions. These genes include the ERAP1, IL1A, and IL23R genes. 

However, it’s important to note that having an inherited gene that is associated with AS or having a family history of AS does not guarantee that you will develop the condition. These factors only increase your risk of receiving an AS diagnosis. In fact, some research even shows that about 75% of people who inherit the HLA-B27 gene from a parent do not develop AS.

Genetic testing can be a helpful tool to identify your risk of AS. If you have a family history of AS and your provider recommends genetic testing, they may refer you to a genetic counselor who can help you understand your test results and personal risk of AS.

Understanding Your Risk 

Researchers have not yet identified a surefire way to prevent AS—mostly because they don’t know what exactly causes the condition. 

However, genetic testing can help you understand your chances of developing the disease. If your results show that you have higher risk of AS, certain lifestyle habits may prevent or delay the onset of AS symptoms. 

There is no specific test that can tell you if you will have AS, but there are certain genetic tests that can determine if you have a higher risk of developing symptoms. 

HLA-B27 Blood Test 

Human leukocyte antigen B27 (HLA-B27) is a protein located on the surface of your white blood cells. Usually, HLA genes help the immune system identify the difference between harmful pathogens (viruses and bacteria) and healthy body tissues. The specific HLA-B27 is associated with immune system dysfunction, which can cause inflammation and increase your risk of developing inflammatory conditions, like AS.

An HLA-B27 test is a simple blood test that checks for HLA-B27 proteins. If your blood test shows that you have HLA-B27 in your blood, you may be at an increased risk of developing an inflammatory autoimmune disorder. Essentially, having the HLA-B27 gene means that your immune system is more likely to attack healthy tissue within your body than people who don’t have this gene.

Genetic Risk Scoring

Genetic risk scoring (GRS) is a newer form of testing that involves obtaining a sample of a person’s DNA—either through a blood test or a cheek swab—to look for genetic mutations that are associated with different health conditions.  

For ankylosing spondylitis, a polygenic risk score (PRS) can help predict your risk of developing AS. The lab technician or genetic counselor in charge of your test will analyze your DNA for genetic mutations. Depending on which genetic mutations you have (if any), your provider will weigh your results with how certain genetic mutations influence the onset of AS symptoms.

Based on their analysis, they will give you a score that can estimate your overall risk of the condition. In most cases, they’ll let you know if you’re at a high risk or low risk for developing AS. 

Keep in mind: the results from this test can only tell you about your risk of developing AS. The score can’t tell you if or when you will develop AS or how the condition will progress.

Making Lifestyle Changes  

While some risk factors (e.g., your age or genes) are not in your control, the good news is that you can modify other risk factors. Making certain lifestyle changes can prevent or delay the onset of AS. These factors include: 

• Reducing tobacco use and smoking: Smoking has been identified as a significant risk factor for the onset and progression of AS. People who smoke tend to receive an AS diagnosis earlier in life than those who don’t smoke. If you smoke, you have a faster disease progression, more pain, and a lower quality of life.
• Getting regular exercise: While regular exercise won’t prevent AS, it can help you increase strength, endurance, and flexibility—which are all important for maintaining your physical functioning and reducing pain in people with AS. Regular exercise can also help you maintain a healthy weight and keep your bones strong, which can improve your overall health.
• Maintaining a weight that is healthy for you: Research shows that being underweight or having obesity can worsen symptoms in people with AS. Being obese may also worsen treatment outcomes if you develop AS.
• Eating a nutritious diet: The foods you eat can help prevent (or contribute to) inflammation in your body. AS is an inflammatory disease, so eliminating foods that trigger inflammation can reduce the inflammation in your body. Eating a diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids (e.g., salmon) may help.

Discuss With Your Healthcare Provider

If you experience symptoms AS symptoms, don’t wait for things to get worse before seeing your healthcare provider. Early diagnosis and treatment can help slow disease progression, reduce the risk of complications, and help you maintain a good quality of life.

A Quick Review 

There is no known way to prevent ankylosing spondylitis. A combination of genetic and environmental risk factors seem to play a role in the development of the disease. Going in for genetic testing can help you understand your risk of AS, while implementing healthy lifestyle changes can prevent or delay the onset of AS symptoms.