Early symptoms of Ankylosing Spondylitis include pain and stiffness in lower back, buttocks and hips. This pain is more in the night & increases with rest. The pain quite often awakens one from sleep particularly in the second half of sleep. One can also have stiffness in the back on getting up that takes 2-3 hours to settle. Neck pain and fatigue also are common. The pain may change locations & affects different parts of the back/ neck & may alternate from one buttock to the other.

The joints & areas most commonly affected are:

• The joint beneath the buttocks (buttock pain)
• The joints of the vertebrae (backache)
• The joints that the ribs have with the vertebrae (pain while taking deep breath)
• The places where tendons and ligaments attach to bones, mainly in the spine, but
• sometimes along the back of your heel & the heel itself (heel pain, pain behind the ankle)
• The cartilage between your breastbone and ribs (chest pain)
• Other joints including the hip, shoulder, ankles.

Ankylosing Spondylitis is an autoimmune condition & the exact cause of this autoimmunity is not known. Genetic factors seem to be involved & it tends to run in families. People who have a gene called HLA-B27 are at a greatly increased risk of developing Ankylosing Spondylitis. There are other genes too that are involved in the causation of Ankylosing Spondylitis. So, one can get Ankylosing Spondylitis without the HLA B27 gene being present. At the same time, every person with the HLA B27 gene need to develop Ankylosing Spondylitis. Only some people with the gene develop the condition.

Risk factors

• Sex - Men are more likely to develop Ankylosing Spondylitis than are women.
• Age — Onset generally occurs in late adolescence or early adulthood.
• Your heredity. Almost 80-90% of those who have Ankylosing Spondylitis have the HLA-B27 gene. However, many people who have this gene never develop Ankylosing Spondylitis.
• Smoking- smoking is linked to a more rapidly progressive Ankylosing Spondylitis. It has been linked with more fusion & progression.

In Ankylosing Spondylitis, over a period of time, calcium gets deposited & new bone forms as part of the body's attempt to heal. This bridges the gap between vertebrae and eventually fuses sections of vertebrae. Those parts of the spine become stiff and inflexible. Fusion can also affect the joints that ribs have with the vertebrae thus restricting deep breathing.

Uncontrolled inflammation of Ankylosing Spondylitis can damage the cartilage of the joints particularly the hip. This leads to osteoarthritis of the hip.

Other complications might include

Eye inflammation (uveitis) At times, the autoimmune process of Ankylosing Spondylitis tends to attack the eyes. This leads to uveitis & can cause eye pain, sensitivity to light and blurred vision.

Compression fractures Despite the excessive calcium deposition, the bones of the vertebrae are often weak. Weakened vertebrae can fracture. This can happen with minor jerks & at times with bending or lifting weights. This can cause sudden increase in the pain. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine.

Heart problems A 2015 review of studies did show that people living with AS had a significantly higher chance of developing coronary artery disease & heart attacks as compared to the general population. (Ungprasert P, Srivali N, Kittanamongkolchai W. Risk of coronary artery disease in patients with Ankylosing Spondylitis: a systematic review and meta-analysis. Ann Transl Med. 2015;3(4):51.) This is possibly due to the long term effect of the inflammation on the heart. Ankylosing Spondylitis can also cause inflammation aorta, the largest artery in the body. The inflamed aorta can distort the shape of the aortic valve in the heart, which impairs its function.

Pregnancy Ankylosing Spondylitis doesn't appear to affect fertility of one’s chances of getting pregnant. Majority of the women with Ankylosing Spondylitis are able to safely deliver a healthy baby. Some medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) — may not be safe to use during pregnancy. Backache, pelvic pain & the spinal fusion may pose a challenge during delivery. Proper planning & prior discussion with a rheumatologist can take care of these issues.

Rheumatoid Arthritis causes pain & swelling in multiple joints. It commonly affects the joints of the hands (knuckles and the first joint of the fingers) & feet. The wrist, elbow, shoulder, knee, and ankle can also be affected. Initially, a person may not experience obvious swelling in the said joints. However, there is pain & stiffness of these joints early in the morning. The stiffness settles after a hot water bath or as the joints are used. Later, as arthritis progresses, the swelling becomes obvious. One may also develop nodular swelling called rheumatoid nodules. These are commonly seen on the forearm below the elbow joint.

Rheumatoid Arthritis is an autoimmune condition & the exact cause of this autoimmunity is not known. Genetic factors seem to be involved & it tends to run in families. However one can suffer from Rheumatoid Arthritis without any family member suffering from it.

• Deformities - if not taken care of, Rheumatoid Arthritis can lead to disabling hand/ feet deformities in the long run. It is also important to note that if properly treated, deformities are uncommon.
• Osteoporosis- Rheumatoid Arthritis itself & steroids that are used to treat it can make the bones weak & fragile. This increase the risk of fractures.
• Eye complications- Rheumatoid Arthritis inflammation can affect the eyes causing scleritis/ episcleritis. Scleritis ((inflammation of the white part of the eye) is a serious condition & can cause vision loss.
• Lung complications- interstitial lung disease- Rheumatoid Arthritis can cause immune attack on the lung & consequent stiffening of the lungs.

Gout can affect anyone. However men are more likely to be affected & get gout earlier than women. Women tend to get affected after menopause.

Gout causes epsiodes or attacks of pain & swelling in the joints. An episode can last 3-10 days. During an episode, the joint swells up & causes intense pain. In the majority, it starts with the joint of the great toe. In between the acute episodes, one does not have any joint pain. If these symptoms are neglected, gout can become chronic. It can then cause persistent pain & swelling in multiple joints.

Uric acid can also get deposited under the skin. These nodules are called tophi. The white colour of the deposited uric acid is often seen under the nodules. They are generally painless but may get inflamed & may ulcerate leading to oozing of the white material (uric acid).

Our body makes a chemical called uric acid during breakdown of chemicals called purines. Purines are chemicals that are naturally created in our body & are also present in our food. Generally about 3/4th of the uric acid comes from the breakdown of purines in the body while 1/4th comes from the food. Generally the body gets rid of the uric acid in urine. However if the consumption of uric acid increases & the body is not able to get rid of uric acid then this leads to a buildup of uric acid in the blood. This in turn can then cause crystallization of the uric acid crystals in the joints leading to an episode of gout.

Risk factors

• Family history A person’s genes can increase the chances of gout. Genes do determine the kidney's handling of uric acid. If the kidney does not excrete uric acid adequately, a buildup of uric acid in the body can start.
• Obesity obesity increase the chances of gout. The more overweight one is, higher are the uric acid levels & higher the chances of gout.
• Gender & age Gout is more common in men than women. Women rarely get gout before menopause. Female hormone estrogen increases the uric acid excretion by the kidneys. Estrogen levels decrease after menopause & uric acid levels increase.
• High alcohol/ protein intake - Higher intake of alcohol/ protein increases the production of uric acid in the body. This may be more than what the kidney can handle & lead to gout.
• Medications: certain medications called diuretics can reduce the ability of the kidneys to take care of the uric acid & lead to increase in the blood uric acid levels.

If not adequately treated, chronic gout can cause deformities of the joints. The gouty tophi can at times compress nerves.