Ankylosing spondylitis

Answer 1

Definition

Ankylosing spondylitis is a long-term disease that causes inflammation of the joints between the spinal bones, and the joints between the spine and pelvis. It eventually causes the affected spinal bones to join together.

See also: Arthritis

Alternative Names

Rheumatoid spondylitis; Spondylitis; Spondylarthropathy; Seronegative bundle arthropathy

Causes, incidence, and risk factors

The cause of ankylosing spondylitis is unknown, but genes seem to play a role.

The disease most often begins between ages 20 and 40, but may begin before age 10. It affects more males than females. Risk factors include:

• Family history of ankylosing spondylitis
• Male gender

Symptoms

The disease starts with low Back pain that comes and goes.

• Pain and stiffness are worse at night, in the morning, or when you are not active. It may wake you from your sleep.
• The pain typically gets better with activity or exercise.
• Back pain may begin in the sacroiliac joints (between the pelvis and the spine). Over time, it may involve all or part of the spine.

You may lose motion or mobility in the lower spine. You may not be able to fully expand your chest because the joints between the ribs are involved.

Fatigue is also a common symptom.

Other, less common symptoms include:

• Eye inflammation or uveitis
• Heel pain
• Hip pain and stiffness
• Joint pain and joint swelling in the shoulders, knees, and ankles
• Loss of appetite
• Slight fever
• Weight loss

Signs and tests

Tests may include:

• CBC
• ESR
• HLA-B27 antigen
• X-rays of the spine and pelvis

Treatment

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Corticosteroid therapy or medications to suppress the immune system may also be prescribed. Drugs called TNF-inhibitors (etanercept, adalimumab, infliximab), which block an inflammatory protein, have been shown to improve the symptoms of ankylosing spondylitis.

Some health care professionals use drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids.

Surgery may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on the back at night can help maintain normal posture.

Expectations (prognosis)

The course of the disease is unpredictable. Symptoms may come and go at any time. Most people are able to function unless the hips are severely involved.

Complications

Rarely, people may have problems with the aortic heart valve (aortic insufficiency) and heart rhythm problems.

Some patients may have pulmonary fibrosis or restrictive lung disease.

Calling your health care provider

Call your health care provider if:

• You have symptoms of ankylosing spondylitis
• You have ankylosing spondylitis and develop new symptoms during treatment

Prevention

Prevention is unknown. Awareness of risk factors may allow early detection and treatment.

References

Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Sidiropoulos PI, Hatemi G, Song IH, et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology (Oxford). 2008. 47(3):355-61.

Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database, Syst Rev. 2008. (1):CD002822.

Answer 2

Ankylosing spondylitis is a chronic form of Arthritis that causes inflammation in spinal joints as well as in the hips. The Centers for Disease Control estimate that 2.4 million people in the United States have been diagnosed with the disease. Many others go undiagnosed due to misidentification of ankylosing spondylitis as other conditions. What causes this condition and how is it treated?

Diagnosis and Causes

Ankylosing spondylitis is found more often in young people aged 17 to 45 and is more common in men than in women. There are risk factors for the disease that include family history, frequent gastrointestinal issues, and carrying the HLA-B27 gene marker. You do not need to have the marker to have ankylosing spondylitis, nor do those with the genetic marker always get the disease. Researchers think there are a number of genes involved in the development of this ailment and often bacterial infections can serve as a catalyst.

While symptoms can vary from person to person, the most common include pain and stiffness on one or both sides of the back and hips. As the disease progresses, the pain will last longer and move from the lower back to the neck and shoulders. Ankylosing spondylitis can also present with fatigue and anemia as the body tries to fight the inflammation. The disease is usually diagnosed by a rheumatologist based on medical records, x-rays, family history, and blood work.

Treatment and Prognosis

Currently, there is no cure for ankylosing spondylitis, but a combination of medication and exercise can help alleviate symptoms and improve quality of life for those that suffer from the disease. Usually NSAIDs work to help relieve the inflammation in the joints, but can cause further gastrointestinal problems. If NSAIDs are not working, anti-rheumatic drugs like Methotrexate are used. In severe cases of ankylosing spondylitis, the spine can fuse together which will limit mobility and effect posture. In more mild cases, sufferers will experience periodic times of pain and inflammation called flare-ups, but can go into remission for months at a time.

Ankylosing spondylitis is a chronic, life long disease that can have serious consequences for your health and mobility. With proper self-care and adherence to a comprehensive course of treatment, patients can alleviate symptoms and still live a long, full life.

Answer 3

Definition

Ankylosing spondylitis is a long-term disease that causes inflammation of the joints between the spinal bones, and the joints between the spine and pelvis. It eventually causes the affected spinal bones to join together.

See also: Arthritis

Alternative Names

Rheumatoid spondylitis; Spondylitis; Spondylarthropathy

Causes, incidence, and risk factors

The cause of ankylosing spondylitis is unknown, but genes seem to play a role.

The disease most often begins between ages 20 and 40, but may begin before age 10. It affects more males than females. Risk factors include:

• Family history of ankylosing spondylitis
• Male gender

Symptoms

The disease starts with low back pain that comes and goes.

• Pain and stiffness are worse at night, in the morning, or when you are not active. It may wake you from your sleep.
• The pain typically gets better with activity or exercise.
• Back pain may begin in the sacroiliac joints (between the pelvis and the spine). Over time, it may involve all or part of the spine.

You may lose motion or mobility in the lower spine. You may not be able to fully expand your chest because the joints between the ribs are involved.

Fatigue is also a common symptom.

Other, less common symptoms include:

• Eye inflammation or uveitis
• Heel pain
• Hip pain and stiffness
• Joint pain and joint swelling in the shoulders, knees, and ankles
• Loss of appetite
• Slight fever
• Weight loss

Signs and tests

Tests may include:

• CBC
• ESR
• HLA-B27 antigen
• X-rays of the spine and pelvis
• MRI of the spine

Treatment

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Corticosteroid therapy or medications to suppress the immune system may also be prescribed. Drugs called TNF-inhibitors (etanercept, adalimumab, infliximab), which block an inflammatory protein, have been shown to improve the symptoms of ankylosing spondylitis.

Some health care professionals use drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids.

Surgery may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on the back at night can help maintain normal posture.

Expectations (prognosis)

The course of the disease is unpredictable. Symptoms may come and go at any time. Most people are able to function unless the hips are severely involved.

Complications

Rarely, people may have problems with the aortic heart valve (aortic insufficiency) and heart rhythm problems.

Some patients may have pulmonary fibrosis or restrictive lung disease.

Calling your health care provider

Call your health care provider if:

• You have symptoms of ankylosing spondylitis
• You have ankylosing spondylitis and develop new symptoms during treatment

Prevention

Prevention is unknown. Awareness of risk factors may allow early detection and treatment.

References

Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Sidiropoulos PI, Hatemi G, Song IH, et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology (Oxford). 2008. 47(3):355-61.

Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database, Syst Rev. 2008. (1):CD002822.

Reviewed By

Review Date: 06/21/2011

Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.