Why is breathing difficult & at times, painful in Ankylosing spondylitis?

June 26, 2016

The mechanical apparatus for breathing consists of the ribs, intercostals muscles, costochondral junctions & the diaphragm. Diaphragm is a muscle located at the base of the chest wall cavity. The ribs move at the joint formed by them with the vertebrae (costovetebral joint). The intercostals muscles are attached to the ribs & are responsible for the movements of the ribs during respiration.

costovetebral joint

During inspiration, the diaphragm moves downwards & expands the chest cavity. At the same time, the ribs move up & out to expand the thoracic cavity. This movement is akin to a bucket handle (moving up). The movement of the ribs is brought about by the contraction of the intercostal muscles.

 

 

In Ankylosing spondylitis, there is inflammation of the costovertebral joint. Later, as AS progresses, the joint may also get fused. This inflammation/ fusion then restricts the movement at the joint & consequently the chest expansion. Physically, this manifests as restricted chest expansion.

Ankylosing spondylitis also leads to inflammation at insertion of intercostal muscles to the ribs (enthesitis). This leads to pain in the rib cage area & also further difficulty in taking a deep breath.

Sneezing involves a rapid & high intensity contraction of the intercostal muscles. It is very painful due to the enthesitis & is almost felt like a ‘catch’

Tight control of AS with NSAIDs/ DMARDs/ biologics/ diet & deep breathing exercises are helpful in reducing this chest pain.

 


What causes foot pain in Ankylosing spondylitis?

June 5, 2016

Foot pain is a common component of Ankylosing Spondylitis (AS) & other seronegative spondyloarthropathies (SpA- psoriatic arthritis, reactive arthritis). In AS/ SpA, the inflammation is predominantly at two locations- within the joints- synovitis & at the attachment of ligaments/ tendons to a bone (enthesitis)

Let us have a look at the various causes of foot pain—

Heel pain– also known as plantar fasciitis. The foot has a bone called calcaneum located at the heel region. A muscular structure ‘plantar fascia’ is attached at the lower end of this bone.

plantar fascia

There is inflammation at the attachment of this fascia to the bone (enthesitis) & causes pain that is generally maximal in the morning & after periods of rest.

plantar fascitis NSAIDs & at times local steroid injection is used to take care of the fasciitis. Persistent inflammation does indicate ongoing inflammation & would require better control of AS/ SpA.

Use of soft footwear & heel cushion/ cup in footwear helps reduce the pain. A simple exercise involving rolling of the foot on top of a bottle in the morning before walking does a lot good in many.

silicon heel cup

Pain at the backside of the foot– this is commonly due to Achilles enthesitis.

Achilles tendon is the thick band like structure at the backside of the foot. This is attached to the calcaneum bone below.

6Inflammation of the attachment (enthesitis) causes pain & localised swelling.

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Achilles enthesitis is a telltale sign of active AS/ SpA & mandates better control with DMARDs/ biologics.

Toe pain—At times, the entire toe may be swollen & painful. This is known as dactylitis & is a feature of AS.

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This is suggestive of ongoing active inflammation.

Pain & swelling at the base of the toe can be due to inflammation of the joint & DMARDs/ steroid injection in the joint/ biologics are used to control it.

Mid foot pain– is generally due to inflammation of the underlying joints especially if associated with swelling. This would require better control of AS.

Ankle & midfoot pain can also be due to a flat foot.

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This would require foot analysis & an insole to correct the flat foot.

foot analysis

All in all, understand your foot pain & discuss with your rheumatologist.

Understanding the reason can help you take better decisions to take control of your AS.

oot pain in AS


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