Connections between Ankylosing Spondylitis (AS) and Vertigo; Causes and Treatment

HEALTH COLUMN

Ankylosing Spondylitis (AS), a type of autoimmune arthritis, involves inflammation in the spine, hips and other joints. People who suffer from AS, tend to experience inflammation in other parts of their body as well.

In many cases, people who have AS, also experience vertigo. Vertigo gives one the sensation of motion in which they feel like everything around them is moving or spinning. This leads to dizziness and balance problems which eventually raise the stake of falling and having injuries.

The cause of Vertigo is changes in our inner ear or brain that affect how we process sensory information. Several inner ear disorders may lead to vertigo. This includes diseases like Meniere's disease, and benign paroxysmal positional vertigo (BPPV).

Some research evidence say that these conditions are more common than average in people with AS. However, more research is needed in this context.

A study carried out in 2012 on 59 patients with AS and 46 without AS, revealed that 6 people with AS experienced vertigo, while only 2 people without AS developed the condition. Another research published in 2011 which involved 690 people concluded a higher prevalence of AS in people with Meniere's disease. This is sometimes manifested as Vertigo.

Medical practitioners are of the view that the studies carried out until then were very small and thus it was difficult to conclude definitely that conditions which cause vertigo are more common in AS.

Back then, there was limited evidence linking the two conditions, doctors used to recommend being evaluated by either a neurologist or ENT who would look for known causes that could possibly be addressed.

What causes vertigo?

Various conditions can lead to the occurrence of vertigo. Some of these are common than average in people with AS.

Meniere's disease

Meniere's disease is one such disease. This inner ear disorder can cause episodes of vertigo, as well as ringing in the ears (tinnitus). It can even lead to hearing loss. It tends to develop gradually over time.

People who suffer from Meniere's disease have a buildup of endolymph in the inner ear. Endolymph is a type of fluid that helps your ear process sound waves. It also plays a role in balance.

Many researchers linked Meniere's disease to inflammatory arthritis, including AS. A study in the year 2011, found that AS was more common than average in people with Meniere's disease.

Limited research was available until then and more research was required to test the potential link between AS and Meniere's disease, including the potential causes. Research was also suggestive of the view that immune changes may play a role.

Benign paroxysmal positional vertigo (BPPV)

BPPV occurs when tiny calcium-carbonate crystals or other substances become loose within our inner ear. These crystals often move into the posterior semicircular canal. This is a tube inside our inner ear. This leads to the occurrence of short but frequent bouts of vertigo when you change the position of your head. Such episodes last for a few minutes or less.

Until 2011, there existed very limited evidence which suggested that people with AS may have an increased risk of BPPV. A study in 2011 compared the incidence of BPPV in 59 people with AS and 46 people without AS. The researchers concluded that 10 percent of people with AS and 2 percent of people without AS had BPPV.

However, this study was not the end to definitive statements. Till then, the medical world was in requirement of more studies to find a potential link between AS and BPPV, including its potential causes.

Research published in 2020 suggests that it is possible that AS-related blood vessel changes, autoimmune processes, or both may contribute to the cause.

Other causes of vertigo

Vertigo may also be caused by other conditions, such as: fistulas, cysts, or bony growths in your inner ear, certain viral infections, including herpes zoster osticus (shingles), certain neurological conditions, including vestibular migraine, stroke, tumors, and multiple sclerosis, head trauma, whiplash, and concussion, a ministroke in the arterial system to the brain, or vertebrobasilar insufficiency, psychological conditions, such as anxiety and somatization disorders

The above conditions imply that AS also raise the risk of stroke and anxiety. AS is also likely to lead to an increase in the risk of inner ear problems such as hearing loss, as well as balance issues.

Over time, AS can lead to the generation of scar tissue. This is formed in the ligaments, tendons, and soft tissue that attach to the spine. This consequently affects the cervical spine, or what we know as our neck.

Researchers have been pondering to find a link between vertigo and cervical spondylosis, described as osteoarthritis in the neck.

One idea suggests that bone spurs in the cervical spine compress the cervical nerve roots, which causes vertigo. Another idea states that bone spurs in the cervical spine put pressure on the vertebral artery, causing vertigo. The exact mechanism for degenerative neck pain to cause vertigo has not been proven. Side effect of certain medications also causes Vertigo.

Balance problems in AS

Vertigo is not the sole reason of balance problems in people with AS.

Chronic inflammation in AS is capable of damaging joints in one's spine, known as vertebrae. Over time, this may cause one's back to become stiff and rounded. AS-related inflammation may also cause pain and stiffness in other joints of your body, such as your hips, knees, and ankles. These changes can negatively affect your posture, ability to move, and balance.

Some people with AS also develop inflammation in the eye, which can cause vision loss. Even small changes in your vision can make it harder to keep your balance.

AS-related fatigue may also contribute to feelings of dizziness and poor balance.

Diagnosis and treatment

If you develop vertigo, let your doctor know.

To figure out the underlying cause, they will: ask you about your symptoms, including when they started, how frequent they are, and how long they last, review your medical history, including recent and current health conditions and any medications that you're taking or conduct a physical exam.

In some cases, they may order tests to check for potential causes or refer you to a specialist for diagnosis.

The treatment plan which the medical practitioner recommends will indicate the underlying cause of your vertigo. With alignment with the cause, the doctor may prescribe one or more of the following: physical therapy with rehabilitation exercises, corticosteroids or other medication or surgery.

Bringing in some changes in one's lifestyle may also help limit vertigo symptoms. It is advisable to limit triggers facilitated by certain activities, foods, or drinks which seem to worsen your vertigo.

Moreover it is important to follow the recommended treatment for AS. Only then you can reduce inflammation, relieving symptoms, and lowering your risk of complications, including possible inner-ear–related complications.

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