How Does Ankylosing Spondylitis Affect the Brain?

Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes back and joint pain in affected patients. Also known as Bechterew’s disease, AS is a form of arthritis that can result in chronic inflammation and spine stiffness.

However, ankylosing spondylitis can result in more than joint pain and inflammation. It can also affect the way the human brain works. It’s important for those impacted by AS to understand the warning signs and symptoms of cognitive dysfunction, as this can empower them to be proactive in prioritizing their health and seeking treatment when needed.

What Is Ankylosing Spondylitis (AS)?

Ankylosing spondylitis is a serious chronic illness that, over time, may cause vertebrae to fuse together. This can result in the spine being less flexible, which can lead to hunched posture and even limit the person’s ability to breathe deeply if ribs are impacted.

AS belongs to a specific class of diseases called spondyloarthropathies. 13 in 1,000 Americans are affected by one of these diseases.

What Causes Ankylosing Spondylitis?

Sadly, the exact cause of ankylosing spondylitis is unknown. However, many experts suspect that genetic factors may play a role in this disease.

Risk Factors

Ankylosing spondylitis largely impacts males and often develops in late adolescence or early adulthood. There are little to no known risk factors for AS; however, medical professionals have linked a gene called HLA-B27 to this particular inflammatory disease.

While not every carrier will develop AS, the disease is more prevalent in those who carry the HLA-B27 gene, leading experts to believe that genetic factors may greatly increase the risk of a person developing ankylosing spondylitis. Approximately 8% of Americans of European descent have this gene, but only one-quarter of them will develop AS.

Symptoms

There is a range of symptoms associated with ankylosing spondylitis that vary in severity, longevity, and persistence. Common AS symptoms include:

• Lower back pain
• Back stiffness
• Hip pain
• Joint pain
• Neck pain
• Difficulty breathing
• Fatigue
• Loss of appetite
• Unexplained weight loss
• Abdominal pain
• Diarrhea
• Skin rash
• Vision problems

Treatments

Although ankylosing spondylitis (AS) is a lifelong disease, there are ways to manage this illness. Potential treatments include:

• Exercise. Physical activity is known to slow or stop the progression of the disease, and many affected patients report worsening pain during periods of inactivity.
• NSAIDs (nonsteroidal anti-inflammatory drugs). Medications such as Ibuprofen, Advil, and Aleve can help alleviate pain and inflammation caused by ankylosing spondylitis.
• DMARDs (disease-modifying anti-rheumatic drugs). Medications like sulfasalazine can help limit the pain and joint swelling caused by ankylosing spondylitis.
• Corticosteroids. These injections can help relieve joint pain and inflammation caused by AS.
• Surgery. In extreme cases, AS patients may undergo medical procedures to treat their condition, such as joint replacement surgery (the implantation of an artificial joint) or kyphoplasty (the correction of a curved spine).

3 Ways Ankylosing Spondylitis Affects the Brain

There are various illnesses associated with cognitive dysfunction. Brain fog and other neurological symptoms can occur as a result of diseases like ankylosing spondylitis, including (but not limited to):

• Multiple sclerosis (MS)
• Chronic fatigue syndrome (CFS)
• Lupus
• Long COVID
• Anxiety
• Depression

The inflammation caused by a chronic illness can affect multiple systems in the body, especially when a disease spreads or worsens over time. Consider the following 3 ways that ankylosing spondylitis can impact the brain:

Brain Fog

Formally known as cognitive dysfunction, “brain fog” is defined as mental sluggishness resulting from another health condition (such as ankylosing spondylitis, MS, or long COVID) that affects a person’s ability to think, focus, or make decisions.

Brain fog can make it challenging for an affected person to:

• Pay attention or concentrate
• Engage in verbal and nonverbal learning
• Exercise short-term and working memory
• Engage in visual and auditory processing
• Problem-solve
• Use motor functioning skills
• Process or respond to information

Memory Loss

Memory loss can also occur as a result of ankylosing spondylitis. Symptoms include:

• Losing objects frequently
• Difficulty finishing a thought or sentence
• Being unable to keep track of time
• Trouble remembering people and places
• Repeating the same questions
• Frequently forgetting appointments and commitments
• Getting lost in known places
• Difficulty following instructions (such as a recipe)
• Inability to practice self-care (such as personal hygiene)
• Engaging in unsafe or reckless behavior

Brain Lesions

Inflammatory diseases like ankylosing spondylitis can result in damage to brain tissue. When this occurs, brain lesions can form. These abnormalities can be diagnosed through medical imaging (such as an MRI or CT scan).

Brain lesions can be small to large in size, and symptoms can vary based on the severity of the lesion. Larger brain lesions can result in neurological deficits, such as weakness on one side of the body. Multiple brain lesions can cause more focal neurological deficits to develop in addition to behavioral changes, fatigue, and/or dizziness.

Is Ankylosing Spondylitis Linked to Brain Damage?

Chronic illnesses like AS can lead to chronic inflammation in the patient's body and are linked to cognitive dysfunction (“brain fog”). Research indicates that those who suffer from AS are prone to experience “widespread brain connectivity alterations” as a result of chronic inflammation.

Why? In a healthy person, inflammation is the body’s well-intentioned way to protect and heal itself. However, in individuals affected by AS and related illnesses, prolonged inflammation can actually damage the body’s cells, including brain cells. This means that certain cognitive processes may be impaired as a result, such as our perception, attention span, memory, and emotions.

In addition to the chronic inflammation experienced by AS patients, additional factors may also be responsible for an increased risk of cognitive dysfunction, such as:

• Chronic pain. Accelerated cognitive decline is linked to chronic pain and can fluctuate in accordance with the pain severity.
• Medications. Some medications and drug interactions can result in side effects, including cognitive dysfunction. Examples include anticholinergics, psychoactive drugs, antidepressants, anticonvulsants, histamine H2 receptor antagonists, corticosteroids, NSAIDs, and some cardiac medications.
• Inadequate sleep. Adequate sleep is essential for healthy cognitive functioning. Sleep disturbances, a common symptom shared by those with ankylosing spondylitis, can impair certain cognitive processes (such as attention, language, reasoning, decision-making, learning, and memory).
• Depression and anxiety. People with ankylosing spondylitis are 51% more likely to develop depression and 85% more likely to be diagnosed with anxiety compared to people without AS. These mental health conditions are linked to higher rates of cognitive decline and a higher risk of dementia.

How Can AS Patients Prioritize Their Health?

If you’re living with ankylosing spondylitis or another chronic disease, you may be wondering how you can be proactive in managing your health. For many Americans living with an incurable condition, it can be difficult to care for their physical wellbeing while also juggling medications, treatments, and the mental and emotional stressors of managing their disease.

However, there are various ways that people affected by AS can stay mindful and practice healthy habits. Consider employing the following practices to prioritize your health:

• Stick to a healthy sleep schedule. Minimize screen time and limit caffeine and sugar intake before bed. Consider taking a warm bath or enjoying a hot cup of tea before bed if you have trouble falling or staying asleep. Be mindful of bright and blue light that could impede your sleep.
• Eat a balanced diet. Modify your eating habits to include more fruits, vegetables, healthy fats, and protein. Do your best to limit processed foods and products high in sugar, calories, or sodium.
• Get regular exercise. Physical activity improves cognitive functioning. Make sure you take the time to engage in daily exercise, whether it’s taking a walk around the block, taking a yoga class, or playing your favorite sport.

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