Ankylosing Spondylitis
What is it?
Ankylosing spondylitis (AS) is a form of arthritis which primarily affects the spine, but may affect other parts of the body as well. This chronic inflammatory disease gradually limits the flexibility of afflicted joints and, in severe cases, causes the vertebrae of the spine to fuse together. Without treatment, fusing of the vertebrae results in a fixed, immobile spine that can be potentially debilitating.
Early diagnosis and treatment can help alleviate pain and stiffness, and may reduce significant distortion of the spine.
Who is at risk?
AS affects about 0.1% to 0.5% of the adult population. The disease may occur at any age and in any sex, but it most commonly affects males between the ages of 15 and 30. Cases in women are generally less severe.
Symptoms
Though symptoms vary widely, the most common early symptoms of AS include:
Chronic pain and stiffness in the lower back
- Pain in the lower back, buttocks, and hips, which continues for more than three months.
- Immobile and/or stiff back and neck.
- Swelling of affected areas
- Possible trouble breathing as upper body begins to curve and chest wall stiffens
- Symptoms can eventually move to extremities, face, and chest
Pain in ligaments and tendons
- Ankylosing Spondylitis may also affect ligaments and tendons attached to bone. Subsequently, inflammation of the afflicted tendons may cause pain and stiffness of the area surrounding the heel, such as that of the Achilles tendon.
Bony fusion
- Ankylosing Spondylitis can cause an overgrowth of the bones as new bones grow in an attempt to fix the damage caused by the chronic inflammation. Such overgrowth results in the irregular fusing of bones, termed “bony fusion”.
- This fusion affects the curvature of the neck and lower back, forcing a change in posture that makes walking and other physical activity difficult
Other
- Since Ankylosing Spondylitis is a systemic disease, symptoms may not be limited to the joints. Affected individuals may experience, in conjunction to the above symptoms, fever, fatigue, and reduced appetite. Eye inflammation can also occur and, in rare cases, heart and lung problems may develop.
Causes
The exact causes are currently unknown, however there is a strong underlying genetic basis to Ankylosing Spondylitis. Certain genes (such as HLA-B, ERAP1, IL1A ARTS1 and IL23R) are strongly associated, but variations in this gene do not guarantee the absence or presence of the disorder. Individuals with a family history of Ankylosing Spondylitis and any of the above symptoms should seek medical attention.
Diagnosis
It can be difficult to diagnose the condition because early symptoms may be mild. An accurate diagnosis involves a doctor carefully monitoring the patient’s symptoms. Further diagnosis might involve monitoring the progress of Ankylosing Spondylitis over time through x-rays, blood tests, antigen testing (to screen for the presence of certain genes), and CT and MRI scans. A combination of these results will then often lead to a final diagnosis.
Treatments
There is no cure as of yet, but there are several methods for treating symptoms. In less severe cases, physical therapy and exercise can help keep the spine and joints flexible. A physical therapist can help develop an exercise routine that includes range-of-motion and stretching exercises.
Swimming is especially helpful as it is easier to move stiff and painful body parts in water. Other techniques for daily management are hot baths, heat, massages, ergonomic furniture, and avoiding putting too much stress on the back.
In more severe cases, non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed. Stronger medicines to control pain and swelling include Corticosteroid therapy, sulfasalzine, methotrexate, and TNF-inhibitors.
Surgery may be performed in very severe cases of pain and joint damage.
Sources:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001457/
http://www.mayoclinic.com/health/ankylosing-spondylitis/DS00483
http://www.medicinenet.com/ankylosing_spondylitis/article.htm
http://www.webmd.com/back-pain/guide/ankylosing-spondylitis
https://www.drugs.com/health-guide/ankylosing-spondylitis.html