Ankylosing Spondylitis

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Ankylosing Spondylitis
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ETIOLOGY/ PATHOPHYSIOLOGY

• Ankylosing spondylitis is a form of arthritis
  that is long-lasting (chronic) and most often
  affects the spine . It can cause pain, stiffness,
  swelling, and limited motion in the low back,
  middle back, and neck, and sometimes areas such
  as the jaw, shoulders, hips, knees, and heels.
  Ankylosing spondylitis is more common in men than
  women.

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CLINICAL MANIFESTATIONS

• inflammation primarily of the joints of the
  spine, but it can also involve inflammation of
  the eye, other joints (especially the hips)
• on occasion, the heart, lungs, and chest wall. If
  the inflammation continues over time, it will
  lead to scarring and permanent damage.
• In some people, the disease is mild and
  progresses slowly, and symptoms never become
  severe. Other people may have a more aggressive
  disease process.

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Mild or early Ankylosing Spondylitis

• usually starts with dull pain in the low back and
  back stiffness. Some people have "flares" of
  increased pain and stiffness that may last for
  several weeks before decreasing again.

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Mild or early Ankylosing Spondylitis

• Affected bones of the low back, middle back,
  hips, or neck may become painful, stiff, and
  limited in motion. Pain tends to increase slowly
  over a period of weeks or months, and it is often
  hard to point to exactly where the pain is.
  Stiffness is usually worse in the morning.
  Physical activity often helps decrease pain and
  stiffness.

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Mild or early Ankylosing Spondylitis

• A feeling of tiredness is common as the disease
  progresses. This tiredness comes from the body
  fighting the inflammatory process that is part of
  ankylosing spondylitis, and from ongoing
  stiffness and pain.

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Mild or early Ankylosing Spondylitis

• The colored part of the eye (iris) may become
  inflamed. This inflammation, called iritis,
  occurs in about 25 to 30 of people with
  ankylosing spondylitis.Symptoms of iritis include
  redness and pain in the eye and sensitivity to
  light.

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Severe or advanced ankylosing spondylitis

• Scarring in the spine causes the joints of the
  spine to grow together (fuse, or "ankylose"). As
  the bones fuse , back pain will gradually go
  away, but the spine will remain very stiff and
  unable to bend. The fused spine is more likely to
  break.

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Severe or advanced ankylosing spondylitis

• The upper spine can curve forward until
  eventually the person has a hard time looking
  straight ahead. In addition, as the spine loses
  its natural curves it becomes hard to balance for
  standing and walking, especially if the hips are
  also affected.

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Severe or advanced ankylosing spondylitis

• Breathing can become difficult as the upper body
  curves forward and the chest wall stiffens.
  Severe ankylosing spondylitis can also cause
  scarring of the lungs (pulmonary fibrosis) and an
  increased risk of lung infection. This can cause
  even greater problems in smokers because their
  lungs are already more prone to lung infection
  and scarring.

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Severe or advanced ankylosing spondylitis

• Scarring in the eye can lead to permanent visual
  impairment and glaucoma.
• In rare cases, the heart muscle can become
  scarred and the heart valves may become inflamed.
  The heart may be unable to pump properly (heart
  failure). The main artery leading from the heart
  (aorta) can also be affected by becoming inflamed
  and enlarged near where it leaves the heart.

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DIAGNOSIS/TREATMENT

• X-rays of the spine and pelvis to check for bone
  changes (bony erosions, fusion, or calcification
  of the spine and sacroiliac joints). Certain
  changes in the sacroiliac joint confirm the
  diagnosis of ankylosing spondylitis, but those
  changes can take several years to develop enough
  to show on X-ray. MRI and ultrasound are both
  being studied as ways to diagnose ankylosing
  spondylitis earlier.

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DIAGNOSIS/TREATMENT

• A genetic test (through a blood test), which may
  be done to determine the presence of a particular
  gene (HLA-B27) that is often associated with
  ankylosing spondylitis. This test will not
  confirm whether you have ankylosing spondylitis.
  However, if you have the HLA-B27 gene, you could
  pass it along to your children. This would
  increase the chances they could get ankylosing
  spondylitis or one of the other
  spondyloarthropathies.

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DIAGNOSIS/TREATMENT

• You will have a physical exam to see how stiff
  your back is and whether you can expand your
  chest normally. Your doctor will also look for
  tender areas, especially over the points of the
  spine, the pelvis, the areas where your ribs join
  your breastbone, and your heels.

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INTERVENTIONS/TEACHING

• Reducing pain by taking pain relievers such as
  nonsteroidal anti-inflammatory drugs, or using
  heat to decrease your pain and stiffness. Warm
  showers or baths or sleeping under a warm
  electric blanket may reduce stiffness.
• Exercising regularly. This reduces pain and
  stiffness and helps maintain fitness and mobility
  of the spine, chest, and joints. Your doctor may
  recommend physical therapy to get you started on
  an exercise program.

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INTERVENTIONS/TEACHING

• Deep breathing exercises can improve or maintain
  lung capacity.
• Swimming as part of your exercise program helps
  to maintain chest expansion and movement of the
  spine without jarring the spine. Breast stroke is
  especially good for chest expansion.
• You should avoid contact sports, since joint
  fusion may make your spine more likely to
  fracture as the disease progresses, but your
  doctor may approve of other activities such as
  golf and tennis.

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INTERVENTIONS/TEACHING

• Maintaining proper posture and chest expansion.
  Good posture is important because it can help
  prevent abnormal bending of the spine .
  Maintaining chest expansion will help prevent
  problems such as lung infection (pneumonia). It's
  a good idea to lie on your stomach a few times
  each day to keep your spine and hips extended.
  For sleeping, choose a firm mattress and a small
  pillow that supports your neck.

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INTERVENTIONS/TEACHING

• Using assistive devices such as canes or walkers.
  Your local chapter of the Arthritis Foundation,
  your physical therapist, or a medical supply
  company may be able to help you find assistive
  devices in your area. If your neck is becoming
  stiff, your doctor may recommend that you wear a
  soft neck brace when you ride in the car, to
  prevent injury in case of an accident .

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INTERVENTIONS/TEACHING

• AVOID SMOKING
• SEE YOUR OPTHAMOLOGIST FOR REGULAR EYE EXAMS
• JOINING A SUPPORT GROUP

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Pictures