Ankylosing spondylitis

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ANKYLOSING SPONDYLITIS
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• Stiffed Spine
• Ankylosing Spondylitis (AS) is a chronic disorder
  which causes recurring inflammation of the bones
  in the head and trunk of the body. It is
  sometimes called Marie-Strümpell disease or
  Bechterew's syndrome. It most commonly affects
  the bones of the spine, but it can also affect
  the pelvis, ribs and even the eyes. Eventually,
  the disease can lead the vertebrae to fuse
  together completely, resulting in a condition
  known as "bamboo spine," in which the spinal
  column becomes completely rigid. AS usually
  begins in early adulthood. Men are more likely
  than women to be affected by the disease.
• Prevalence
• AS is most prevalent in Afro-Caribbean
  populations and Northern European countries. The
  overall prevalence of the disease is less than
  0.3 of the general population. AS is diagnosed
  twice as often in men as in women, but many
  doctors believe the number of women with the
  disease is underestimated because women tend to
  have milder symptoms. Typically, signs and
  symptoms of AS usually first appear between the
  ages of 15 and 25.
• Risk Factors
• Sex Males are more likely to develop ankylosing
  spondylitis than females.
• Age The onset of ankylosing spondylitis
  generally occurs late in adolescence or in early
  adulthood.
• Heredity The majority of people who develop
  ankylosing spondylitis have a specific gene known
  as the HLA-B27 gene. However, there are also many
  people who have the HLA-B27 gene who never
  develop AS.

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• Reasons
• We still have a lot to learn about what causes
  ankylosing spondylitis, but we do know quite a
  lot about what effects it has on the body, and
  why it causes the vertebrae to become stiff and
  rigid.
• People who have the particular HLA-B27 gene have
  a significantly greater risk of developing AS. It
  is also possible that infectious agents may be
  involved in the development of the disease.
• Classification
• There are four different types of ankylosing
  spondylitis
• Slowly progressive
• Slowly progressive with periods of exacerbations
• Quick progressive
• Septic

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• Symptoms
• Pain and stiffness, especially in the lower back
  and hips are two common symptoms of ankylosing
  spondylitis. These symptoms may be worse in the
  morning upon arising and after periods of
  prolonged inactivity. The symptoms my worsen over
  time, or they may gradually improve. In some
  cases, the pain and stiffness stop completely at
  times.
• Ankylosing spondylitis is a disease that affects
  the bones and joints of the skeleton. The most
  common areas to be affected are
• The joint that connects your pelvis and the base
  of your spine
• The vertebrae located in your lower back
• Places where your tendons and ligaments are
  attached to bones. This mainly affects the spine,
  but occasionally affects the tissues in the back
  of the heel.
• The tissues (cartilage) in between the ribs and
  the breastbone
• The hip joints and the joints of the shoulders

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Diagnostic procedures There is no single
specific test to confirm a diagnosis of
ankylosing spondylitis. Your physician will most
likely complete a thorough physical examination
to rule out other causes for your symptoms. The
major diagnostic tools used when AS is suspected
are magnetic resonance imaging (MRI), X-rays of
the spine, which will reveal specific changes in
the spine and blood tests to check for
inflammation and for the presence of the
characteristic genetic marker. X-Rays An x-ray
can reveal changes in the joints caused by AS,
but many times these changes are not visible on a
plain x-ray until the disease has been
progressing for 8-10 years. MRI Magnetic
resonance imaging tests may lead to an earlier
diagnosis, but the reliability of MRIs in
diagnosing AS has not been firmly
established. Blood parameters During an acute
flare-up of the disease, some AS patients will
have an increase of certain blood components (CRP
and ESR). But in other patients who have an
extreme amount of inflammation, these levels do
not increase. So these blood tests alone are not
an accurate diagnostic tool. Genetic
testing People with the HLA-B27 gene are at
greater risk of developing AS than the general
population. A blood test for this genetic marker
can help in the diagnosis, but alone, it is not a
diagnosis, as not everyone with this marker
develops AS.
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Pathological Changes Ankylosing
spondylitis causes changes to occur in your body
because of the inflammation it causes in the
areas where skeletal bones are attached to
tendons, ligaments, discs or joints. It typically
affects the sacroiliac joints, where the lower
back meets the pelvis, and begins with
inflammation in this area (sacroiliitis). In the
spinal column, AS starts in the fibrous tissues
of the discs between the vertebrae. It causes
inflammation that leads to the breakdown of the
tissues and, over time, makes them thickened and
rigid. This leads to stiffness of the spine, and
pain due to compression of the nerve
roots. Eventually, prolonged and recurrent
inflammation can result in a complete fusion or
cementing together of the bones of the spine
(vertebrae). This fusion is called ankylosis.
When the spine is fused, it loses its
mobility. Because it is a systemic inflammatory
disease, ankylosing spondylitis can affect other
areas of the body away from the spine, such as
the kidneys, heart, lungs and eyes.
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• Treatment
• The treatment for ankylosing spondylitis is most
  beneficial when it is started early before the
  inflammation has caused joint damage that cannot
  be reversed. The goals of treatment are aimed at
• Relieving the stiffness and controlling pain
• Preventing or delaying complications
• Preventing or delaying spinal deformities
• Medications
• The medications most commonly used to treat
  ankylosing spondylitis are nonsteroidal
  anti-inflammatory drugs (NSAIDs), such as
  naproxen, ibuprofen and aspirin. These
  medications help to reduce swelling and
  inflammation as well as help to relieve pain. One
  of the side effects is gastrointestinal bleeding,
  so they must be taken with food.
• If NSAIDs are not effective in controlling the
  pain and inflammation of AS, your doctor may
  prescribe tumor necrosis factor (TNF) blocker
  medications. These drugs are sometimes used to
  treat rheumatoid arthritis. They work by reducing
  your body's inflammatory response and so
  stiffness, pain and swelling also decreased. TNFs
  are given by an injection under the skin or into
  a vein (intravenously). Examples of these drugs
  include
• Adalimumab (Humira)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)
• People who are risk for developing tuberculosis,
  have latent TB or who have decreased immunity
  should not take TNFs because these drugs
  interfere with the body's natural ability to
  fight infection.

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• Therapy
• Physical therapy can provide many strategies for
  dealing with ankylosing spondylitis. Some of the
  benefits include
• Posturing education to help reduce pain and
  prevent complications
• Stretching exercises and Range of motion
  exercises to help maintain joint flexibility and
  mobility
• Aerobic exercise to increase or maintain
  endurance
• Pain management techniques
• Proper sleep positioning
• Use of adaptive equipment or assistive devices
• Safety instruction and energy conservation
  techniques
• Surgery
• Surgery is not recommended for most people with
  AS,
• but if your hip or other joints are severely
  damaged,
• your physician may recommend surgery. Surgery is
  also