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Ankylosing Spondylitis (AS)

SYMPTOMS Most Common Symptoms It is important to note that the course of ankylosing spondylitis varies greatly from person to person. So too can the onset of symptoms. Although symptoms usually start to appear in late adolescence or early adulthood (ages 17-35 ! the symptoms can occur in children or much later. "ypically! the first symptoms of AS are fre#uent pain and stiffness in the lo$er %ack and %uttocks! $hich comes on gradually over the course of a fe$ $eeks or months. At first! discomfort may only %e felt on one side! or alternate sides. "he pain is usually dull and diffuse! rather than locali&ed. "his pain and stiffness is usually $orse in the mornings and during the night! %ut may %e improved %y a $arm sho$er or light e'ercise. Also! in the early stages of AS! there may %e mild fever! loss of appetite and general discomfort. "he pain normally %ecomes persistent (chronic and is felt on %oth sides! usually persisting for at least three months. (ver the course of months or years! the stiffness and pain can spread up the spine and into the neck. )ain and tenderness spreading to the ri%s! shoulder %lades! hips! thighs and heels is possi%le as $ell. *ote that AS can present differently at onset in $omen than in men. +uoting ,r. -laine Adams! ./omen often present in a little more atypical fashion so it0s even harder to make the diagnoses in $omen.. 1or e'ample! anecdotally $e have heard from $omen $ith AS $ho have stated that their symptoms started in the neck rather than in the lo$er %ack. 2arying levels of fatigue may also result from the inflammation caused %y AS. "he %ody must e'pend energy to deal $ith the inflammation! thus causing fatigue. Also! mild to moderate anemia! $hich may also result from the inflammation! can contri%ute to an overall feeling of tiredness. Overheard in a Message Board Conversation: "I like to refer to A.S. as being the 'camouflage disorder' that cree s through !our bod!. A erson "ith A.S. can look e#tremel! normal but can feel absolutel! a"ful. $he ain doesn't limit itself to %ust one area of the bod! as it can travel from head to toe& and it all starts "ithin." ' oster ratherken ()en *rather& Indiana and Ohio AS Su ort +rou Coordinator, Other Symptoms In a minority of individuals! the pain does not start in the lo$er %ack! %ut in a peripheral 3oint such as the hip! ankle! el%o$! knee! heel or shoulder. "his pain is commonly caused %y enthesitis! $hich is the inflammation of the site $here

a ligament or tendon attaches to %one. Inflammation and pain in peripheral 3oints is more common in 3uveniles $ith AS. "his can %e confusing since! $ithout the immediate presence of %ack pain! AS may look like some other form of arthritis. 4any people $ith AS also e'perience %o$el inflammation! $hich may %e associated $ith 5rohn0s ,isease or ulcerative colitis. AS is often accompanied %y iritis or uveitis (inflammation of the eyes . A%out one third of people $ith AS $ill e'perience inflammation of the eye at least once. Signs of iritis or uevitis are6 -ye(s %ecoming painful! $atery! red and individuals may e'perience %lurred vision and sensitivity to %right light. 5lick here for more information on the complications of AS! including iritis7uveitis. Advanced Symptoms Advanced symptoms can %e chronic! severe pain and stiffness in the %ack! spine and possi%ly peripheral 3oints! as $ell as lack of spinal mo%ility %ecause of chronic inflammation and possi%le spinal fusion.

Ankylosing spondylitis
Ankylosing spondylitis is one of many forms of inflammatory arthritis! the most common of $hich is rheumatoid arthritis. Ankylosing spondylitis primarily causes inflammation of the 3oints %et$een the verte%rae of your spine and the 3oints %et$een your spine and pelvis (sacroiliac 3oints . 8o$ever! ankylosing spondylitis may also cause inflammation and pain in other parts of your %ody6

/here your tendons and ligaments attach to %ones 9oints %et$een your ri%s and spine 9oints in your hips! shoulders! knees and feet :our eyes

As ankylosing spondylitis $orsens and the inflammation persists! ne$ %one forms as a part of the %ody0s attempt to heal. :our verte%rae %egin to gro$ together! forming vertical %ony outgro$ths (syndesmophytes and %ecoming stiff and infle'i%le. 1usion can also stiffen your ri% cage! restricting lung capacity and function. Also called spondylitis or rheumatoid spondylitis! ankylosing spondylitis is a chronic condition. "reatments can decrease your pain and lessen your symptoms. -ffective treatment may also help prevent complications and physical deformities.

Signs and symptoms

CLIC TO !"LA#$! 4an $ith ankylosing spondylitis

:our condition may change over time! $ith symptoms getting $orse! improving or completely stopping at any point. -arly signs and symptoms may include pain and stiffness in your lo$er %ack and hips ; $hich is often $orse in the morning! at night and after periods of inactivity. (ver time! the pain and stiffness may progress up your spine and to other 3oints! such as those in your hips! shoulders! knees and feet. In advanced stages! the follo$ing signs and symptoms may develop6

<estricted e'pansion of your chest 5hronic stooping Stiff! infle'i%le spine 1atigue =oss of appetite /eight loss -ye inflammation (iritis >o$el inflammation

Ca%ses
Ankylosing spondylitis has no kno$n specific cause! though genetic factors seem to %e involved. In particular! people $ho have a gene called 8=A->?7 are at significantly increased risk of developing ankylosing spondylitis.

#isk &actors
@enetics may play a role in the development of ankylosing spondylitis. In fact! the ma3ority of people $ith this condition have the 8=A->?7 gene. 8aving this gene doesn0t mean that you0ll ac#uire ankylosing spondylitis ; no more than ? percent of people $ith this gene develop the condition ; %ut it may make you more suscepti%le to the disease. If you test positive for the 8=A->?7 gene! are younger than AB and have a family mem%er $ith ankylosing spondylitis! you have a%out a one in five chance of developing the condition. 8o$ever! if you0re older than AB! your chances of ac#uiring ankylosing spondylitis are lo$. If you have ankylosing spondylitis! you

have a%out a 5B percent chance of passing the 8=A->?7 gene on to your children if you have the gene. Ankylosing spondylitis affects males more often! and its onset generally occurs %et$een the ages of 1C and AB. In the Dnited States! ankylosing spondylitis is most common among some American Indian tri%es.

Screening and diagnosis


,iagnosis of ankylosing spondylitis may %e delayed if your symptoms are mild or if you mistakenly attri%ute some of your symptoms to more common %ack pro%lems. "o determine the cause of your discomfort! your doctor $ill conduct a medical history and complete a physical e'amination. "hen! your doctor may use the follo$ing diagnostic procedures6

'(rays or other imaging) E-rays allo$ your doctor to check for changes in your 3oints and %ones! though the characteristic effects of ankylosing spondylitis may not %e evident early in the disease. :our doctor may also use other imaging tests! such as computeri&ed tomography (5" or magnetic resonance imaging (4<I scans! to detect inflammation and other changes in your 3oints. *lood tests) :our doctor may check for indications of inflammation using one or more %lood tests! including erythrocyte sedimentation rate (-S< and 5-reactive protein (5<) . In the -S< test! inflammation is signaled %y elevation in the speed at $hich your red %lood cells settle to the %ottom of a tu%e of %lood in one hour. "he 5<) test indicates inflammation %y the presence of a protein that your liver produces as part of your immune system response to in3ury or infection. (ther tests used to diagnose ankylosing spondylitis include a complete %lood count (5>5 to determine if you have anemia! a condition in $hich there aren0t enough healthy red %lood cells to carry ade#uate o'ygen to your tissues. Anemia is a complication that can result from the chronic inflammation of ankylosing spondylitis. 1inally! your doctor may check your %lood for the 8=A->?7 gene. "he presence of this gene doesn0t determine $hether you have ankylosing spondylitis. >ut its a%sence makes it less likely that you do.

Complications
Ankylosing spondylitis doesn0t follo$ a set course. "he severity of symptoms and development of complications vary $idely among individuals. 5omplications may include6

+i&&ic%lty ,alking or standing) "ypically! ankylosing spondylitis %egins $ith soreness in your lo$er %ack. As the disease progresses! the affected %ones may fuse together! rendering your 3oints immo%ile and causing a stiff! infle'i%le spine (%am%oo spine . "his can make $alking or standing difficult. :our 3oints may fuse even if you undergo proper treatment ; and once 3oints fuse! additional treatment $on0t help restore mo%ility. 8o$ever! if fusion occurs $ith your spine in an upright position! you can remain more a%le to perform activities of daily living. +i&&ic%lty -reathing) Inflammation can also spread up your spine and cause the %ones in your ri% cage to fuse. "his results in %reathing pro%lems. /hen your ri%s can0t move $hen you %reathe! it0s difficult to fully inflate your lungs. 8o$ever! if you don0t have an unrelated lung condition! you may %e a%le to continue your everyday activities $ithout e'periencing shortness of %reath. .eart pro-lems) If the inflammation reaches your heart! you can develop valve pro%lems! such as inflammation of the %ody0s largest artery (aorta ! also kno$n as aortitis. Another possi%le complication is aortic valve regurgitation! $hich occurs $hen the aortic ring and aortic valve are distorted. L%ng in&ections) In some people $ith ankylosing spondylitis! cavitary lesions develop in the upper portion of the lungs. "hese cavities can slo$ly enlarge over many years and develop infections! most commonly fungal infections.

Inflammation can also involve other parts of your %ody! resulting in conditions such as6

Inflammatory %o$el disease Anemia )ainful and inflamed eyes (iritis

Treatment
"he goal of treatment is to relieve pain and stiffness! and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful early! %efore it causes irreversi%le damage to your 3oints! such as fusion! especially in positions that limit your function. Medications :our doctor may recommend that you take one or more of the follo$ing medications6

"onsteroidal anti(in&lammatory dr%gs ("SAI+s)) *SAI,s ; such as napro'en (Aleve! *aprosyn and indomethacin (Indocin ; are the

medications doctors most commonly use to treat ankylosing spondylitis. "hey can relieve your inflammation! pain and stiffness. +isease(modi&ying antirhe%matic dr%gs (+MA#+s)) :our doctor may prescri%e a ,4A<,! such as sulfasala&ine (A&ulfidine or methotre'ate (<heumatre' ! to treat inflamed 3oints of the legs and arms and other tissues. "his class of drugs helps limit the amount of 3oint damage that occurs. Corticosteroids) "hese medications! such as prednisone! may suppress inflammation and slo$ 3oint damage in severe cases of ankylosing spondylitis. :ou usually take them orally! ideally for a limited period of time %ecause of their side effects. (ccasionally! corticosteroids are in3ected directly into a painful 3oint. T%mor necrosis &actor (T"/) -lockers) ,octors originally used "*1 %lockers to treat rheumatoid arthritis. "*1 is a cytokine! or cell protein! that acts as an inflammatory agent in rheumatoid arthritis. "*1 %lockers target or %lock this protein and can help reduce pain! stiffness! and tender or s$ollen 3oints. "hese medications! such as adalimuma% (8umira ! etanercept (-n%rel and infli'ima% (<emicade ! may decrease inflammation and improve pain and stiffness for people $ith ankylosing spondylitis.

Physical therapy )hysical therapy can provide a num%er of %enefits! from pain relief to improved physical strength and fle'i%ility. :our doctor may recommend that you meet $ith a physical therapist to provide you $ith specific e'ercises designed for your needs. <ange-of-motion and stretching e'ercises can help maintain fle'i%ility in your 3oints and preserve good posture. In addition! specific %reathing e'ercises can help to sustain and enhance your lung capacity. As your condition $orsens! your upper %ody may %egin to stoop for$ard. )roper sleep and $alking positions and a%dominal and %ack e'ercises can help maintain your upright posture. "hough you may develop spine stiffness despite your treatment! proper posture can help to ensure that your spine is fused in a fi'ed upright position. S%rgery 4ost people $ith ankylosing spondylitis don0t need surgery. 8o$ever! your doctor may recommend surgery if you have severe pain or 3oint damage! or if a nonspinal 3oint is so damaged that it needs to %e replaced. Spinal surgery is only rarely re#uired.

Prevention

>ecause genetic factors appear to play a part in ankylosing spondylitis! it0s not possi%le to prevent the disease. 8o$ever! %eing a$are of any personal risk factors for the disease can help in early detection and treatment. )roper and early treatment can relieve 3oint pain and help to prevent or delay the onset of physical deformities.

Sel&(care
If you smoke! #uit. Smoking is %ad for your health! %ut creates additional pro%lems for people $ith ankylosing spondylitis. ,epending on the severity of your condition! ankylosing spondylitis can affect the mo%ility of your ri% cage. ,amaging your lungs %y smoking can further compromise your a%ility to %reathe.

Coping skills
"he course of your condition may change over time! and you may e'perience relapses and remissions throughout your life. >ut despite the potential complications! most people are a%le to live productive lives despite a diagnosis of ankylosing spondylitis. :ou may $ant to 3oin a support group of other people $ith this condition! in order to share e'periences and support. 5ontact your local office of the Spondylitis Association of America or the Arthritis 1oundation to see if there are any groups in your area or if you can start your o$n.

Spondylitis
/rom 0ikipedia1 the &ree encyclopedia
Spondylitis is an inflammation of a verte%ra. Any disorder of the spinal column may %e called spondylopathy! also. 0hat is spondylitis2 Spondylitis (pronounced spon-d-lie-tiss is the name given to a group of chronic or long lasting diseases also called Spondyloarthritis (spon-dyl-oh-arthritis or Spondyloarthropathy (spon-d-lo$-are-throp-ah-thee . "hese diseases are forms of inflammatory arthritis that primarily affect the spine! although other 3oints and organs can %ecome involved. "he group of diseases in the spondylitis family includesF1G6

Ankylosing spondylitis (AS - Ankylosing spondylitis is the primary disease in the spondylitis family of diseases and is a form of chronic autoimmune arthritis that primarily affects the spine and sacroiliac 3oints! although other 3oints can %ecome involved. (ccurring primarily in young adults! (age of onset normally %efore age 35 ! AS causes inflammation of the spinal 3oints (verte%rae that can lead to severe! chronic pain and discomfortF?G. Dndifferentiated spondyloarthropathy (DSpA - Dndifferentiated Spondyloarthropathy (DSpA is a term used to descri%e symptoms and signs of spondylitis in someone $ho does not meet the criteria for a definitive diagnosis of AS or related disease. (ver time! some people $ith DSpA $ill develop a $ell-defined form of spondylitis such as ankylosing spondylitis F3G. 9uvenile spondyloarthropathy (9SpA - 9uvenile-onset spondyloarthritis (9SpA ! also kno$n as 9uvenile Spondyloarthropathy! is the medical term for a group of childhood rheumatic diseases! $hich cause arthritis %efore the age of 1C and may span through adult life. 9SpA typically causes pain and inflammation in the 3oints in the lo$er part of the %ody! for e'ample! the pelvis! hips! knees and anklesFAG. )soriatic arthritis ()sA - In 5-1BH of those $ith psoriasis! arthritis also appears. In most cases! the psoriasis $ill precede the arthritis! sometimes %y many years. /hen arthritis symptoms occur $ith psoriasis! it is called psoriatic arthritis ()sAF5G . <eactive arthritis (<eA - <eactive Arthritis (also kno$n as <eiter0s Syndrome is a form of arthritis that can cause inflammation and pain in the 3oints! the skin! the eyes! the %ladder! the genitals and the mucus mem%ranes. <eactive arthritis is thought to occur as a .reaction. to an infection that started else$here in the %ody! generally in the genitourinary or gastrointestinal tractFCG. -nteropathic arthritis - -nteropathic (en-ter-o-path-ic arthritis is a form of chronic! inflammatory arthritis associated $ith the occurrence of an inflammatory %o$el disease (I>, ! the t$o %est-kno$n types of $hich are ulcerative colitis and 5rohn0s disease. "he most common areas affected %y enteropathic arthritis are inflammation of the peripheral (lim% 3oints! as $ell as the a%dominal pain and possi%ly %loody diarrhea associated $ith the I>, component of the diseaseF7G.

)ott0s disease - a form of spondylitis that is the result of e'trapulmonary tu%erculosis.