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.
Typically, the first symptoms of AS are frequent pain and stiffness in the lower
back and buttocks, which comes on gradually over the course of a few weeks or
months. At first, discomfort may only be felt on one side, or alternate sides.
The pain is usually dull and diffuse, rather than localized. This pain and
stiffness is usually worse in the mornings and during the night, but may be
improved by a warm shower or light exercise. Also, in the early stages of AS,
there may be mild fever, loss of appetite and general discomfort.
The pain normally becomes persistent (chronic) and is felt on both sides,
usually persisting for at least three months. Over the course of months or
years, the stiffness and pain can spread up the spine and into the neck. Pain
and tenderness spreading to the ribs, shoulder blades, hips, thighs and heels is
possible as well.
Note that AS can present differently at onset in women than in men. Quoting
Dr. Elaine Adams, "Women often present in a little more atypical fashion so it's
even harder to make the diagnoses in women." For example, anecdotally we
have heard from women with AS who have stated that their symptoms started
in the neck rather than in the lower back.
Varying levels of fatigue may also result from the inflammation caused by AS.
The body must expend energy to deal with the inflammation, thus causing
fatigue. Also, mild to moderate anemia, which may also result from the
inflammation, can contribute 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 creeps through your body. A person with A.S.
can look extremely normal but can feel absolutely awful. The pain doesn't
limit itself to just one area of the body as it can travel from head to toe, and
it all starts within." - poster pratherken (Ken Prather, Indiana and Ohio AS
Support Group Coordinator)
Other Symptoms
In a minority of individuals, the pain does not start in the lower back, but in a
peripheral joint such as the hip, ankle, elbow, knee, heel or shoulder. This pain
is commonly caused by enthesitis, which is the inflammation of the site where

a ligament or tendon attaches to bone. Inflammation and pain in peripheral

joints is more common in juveniles with AS. This can be confusing since,
without the immediate presence of back pain, AS may look like some other
form of arthritis.
Many people with AS also experience bowel inflammation, which may be
associated with Crohn's Disease or ulcerative colitis.
AS is often accompanied by iritis or uveitis (inflammation of the eyes). About
one third of people with AS will experience inflammation of the eye at least
once. Signs of iritis or uevitis are: Eye(s) becoming painful, watery, red and
individuals may experience blurred vision and sensitivity to bright light. Click
here for more information on the complications of AS, including iritis/uveitis.
Advanced Symptoms
Advanced symptoms can be chronic, severe pain and stiffness in the back,
spine and possibly peripheral joints, as well as lack of spinal mobility because
of chronic inflammation and possible spinal fusion.

Ankylosing spondylitis
Ankylosing spondylitis is one of many forms of inflammatory arthritis, the most
common of which is rheumatoid arthritis. Ankylosing spondylitis primarily
causes inflammation of the joints between the vertebrae of your spine and the
joints between your spine and pelvis (sacroiliac joints). However, ankylosing
spondylitis may also cause inflammation and pain in other parts of your body:

Where your tendons and ligaments attach to bones

Joints between your ribs and spine
Joints in your hips, shoulders, knees and feet
Your eyes

As ankylosing spondylitis worsens and the inflammation persists, new bone

forms as a part of the body's attempt to heal. Your vertebrae begin to grow
together, forming vertical bony outgrowths (syndesmophytes) and becoming
stiff and inflexible. Fusion can also stiffen your rib cage, restricting lung
capacity and function.
Also called spondylitis or rheumatoid spondylitis, ankylosing spondylitis is a
chronic condition. Treatments can decrease your pain and lessen your
symptoms. Effective treatment may also help prevent complications and
physical deformities.

Signs and symptoms

CLICK TO ENLARGE
Man with ankylosing spondylitis

Your condition may change over time, with symptoms getting worse, improving
or completely stopping at any point. Early signs and symptoms may include pain
and stiffness in your lower back and hips which is often worse in the
morning, at night and after periods of inactivity. Over time, the pain and
stiffness may progress up your spine and to other joints, such as those in your
hips, shoulders, knees and feet.
In advanced stages, the following signs and symptoms may develop:

Restricted expansion of your chest

Chronic stooping
Stiff, inflexible spine
Fatigue
Loss of appetite
Weight loss
Eye inflammation (iritis)
Bowel inflammation

Causes
Ankylosing spondylitis has no known specific cause, though genetic factors
seem to be involved. In particular, people who have a gene called HLA-B27 are
at significantly increased risk of developing ankylosing spondylitis.

Risk factors
Genetics may play a role in the development of ankylosing spondylitis. In fact,
the majority of people with this condition have the HLA-B27 gene. Having this
gene doesn't mean that you'll acquire ankylosing spondylitis no more than 2
percent of people with this gene develop the condition but it may make you
more susceptible to the disease.
If you test positive for the HLA-B27 gene, are younger than 40 and have a
family member with ankylosing spondylitis, you have about a one in five chance
of developing the condition. However, if you're older than 40, your chances of
acquiring ankylosing spondylitis are low. If you have ankylosing spondylitis, you

have about a 50 percent chance of passing the HLA-B27 gene on to your

children if you have the gene.
Ankylosing spondylitis affects males more often, and its onset generally occurs
between the ages of 16 and 40. In the United States, ankylosing spondylitis is
most common among some American Indian tribes.

Screening and diagnosis

Diagnosis of ankylosing spondylitis may be delayed if your symptoms are mild or
if you mistakenly attribute some of your symptoms to more common back
problems.
To determine the cause of your discomfort, your doctor will conduct a medical
history and complete a physical examination. Then, your doctor may use the
following diagnostic procedures:

X-rays or other imaging. X-rays allow your doctor to check for changes
in your joints and bones, though the characteristic effects of ankylosing
spondylitis may not be evident early in the disease. Your doctor may also
use other imaging tests, such as computerized tomography (CT) or
magnetic resonance imaging (MRI) scans, to detect inflammation and
other changes in your joints.
Blood tests. Your doctor may check for indications of inflammation using
one or more blood tests, including erythrocyte sedimentation rate (ESR)
and C-reactive protein (CRP). In the ESR test, inflammation is signaled
by elevation in the speed at which your red blood cells settle to the
bottom of a tube of blood in one hour. The CRP test indicates
inflammation by the presence of a protein that your liver produces as
part of your immune system response to injury or infection.
Other tests used to diagnose ankylosing spondylitis include a complete
blood count (CBC) to determine if you have anemia, a condition in which
there aren't enough healthy red blood cells to carry adequate oxygen to
your tissues. Anemia is a complication that can result from the chronic
inflammation of ankylosing spondylitis. Finally, your doctor may check
your blood for the HLA-B27 gene. The presence of this gene doesn't
determine whether you have ankylosing spondylitis. But its absence
makes it less likely that you do.

Complications
Ankylosing spondylitis doesn't follow a set course. The severity of symptoms
and development of complications vary widely among individuals.
Complications may include:

Difficulty walking or standing. Typically, ankylosing spondylitis begins

with soreness in your lower back. As the disease progresses, the affected
bones may fuse together, rendering your joints immobile and causing a
stiff, inflexible spine (bamboo spine). This can make walking or standing
difficult. Your joints may fuse even if you undergo proper treatment
and once joints fuse, additional treatment won't help restore mobility.
However, if fusion occurs with your spine in an upright position, you can
remain more able to perform activities of daily living.
Difficulty breathing. Inflammation can also spread up your spine and
cause the bones in your rib cage to fuse. This results in breathing
problems. When your ribs can't move when you breathe, it's difficult to
fully inflate your lungs. However, if you don't have an unrelated lung
condition, you may be able to continue your everyday activities without
experiencing shortness of breath.
Heart problems. If the inflammation reaches your heart, you can
develop valve problems, such as inflammation of the body's largest
artery (aorta), also known as aortitis. Another possible complication is
aortic valve regurgitation, which occurs when the aortic ring and aortic
valve are distorted.
Lung infections. In some people with ankylosing spondylitis, cavitary
lesions develop in the upper portion of the lungs. These cavities can
slowly enlarge over many years and develop infections, most commonly
fungal infections.

Inflammation can also involve other parts of your body, resulting in conditions
such as:

Inflammatory bowel disease

Anemia
Painful and inflamed eyes (iritis)

Treatment
The goal of treatment is to relieve pain and stiffness, and prevent or delay
complications and spinal deformity. Ankylosing spondylitis treatment is most
successful early, before it causes irreversible damage to your joints, such as
fusion, especially in positions that limit your function.
Medications
Your doctor may recommend that you take one or more of the following
medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as

naproxen (Aleve, Naprosyn) and indomethacin (Indocin) are the

medications doctors most commonly use to treat ankylosing spondylitis.

They can relieve your inflammation, pain and stiffness.
Disease-modifying antirheumatic drugs (DMARDs). Your doctor may
prescribe a DMARD, such as sulfasalazine (Azulfidine) or methotrexate
(Rheumatrex), to treat inflamed joints of the legs and arms and other
tissues. This class of drugs helps limit the amount of joint damage that
occurs.
Corticosteroids. These medications, such as prednisone, may suppress
inflammation and slow joint damage in severe cases of ankylosing
spondylitis. You usually take them orally, ideally for a limited period of
time because of their side effects. Occasionally, corticosteroids are
injected directly into a painful joint.
Tumor necrosis factor (TNF) blockers. Doctors originally used TNF
blockers to treat rheumatoid arthritis. TNF is a cytokine, or cell protein,
that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers
target or block this protein and can help reduce pain, stiffness, and
tender or swollen joints. These medications, such as adalimumab
(Humira), etanercept (Enbrel) and infliximab (Remicade), may decrease
inflammation and improve pain and stiffness for people with ankylosing
spondylitis.

Physical therapy
Physical therapy can provide a number of benefits, from pain relief to
improved physical strength and flexibility. Your doctor may recommend that
you meet with a physical therapist to provide you with specific exercises
designed for your needs.
Range-of-motion and stretching exercises can help maintain flexibility in your
joints and preserve good posture. In addition, specific breathing exercises can
help to sustain and enhance your lung capacity.
As your condition worsens, your upper body may begin to stoop forward. Proper
sleep and walking positions and abdominal and back exercises can help
maintain your upright posture. Though you may develop spine stiffness despite
your treatment, proper posture can help to ensure that your spine is fused in a
fixed upright position.
Surgery
Most people with ankylosing spondylitis don't need surgery. However, your
doctor may recommend surgery if you have severe pain or joint damage, or if a
nonspinal joint is so damaged that it needs to be replaced. Spinal surgery is
only rarely required.

Prevention

Because genetic factors appear to play a part in ankylosing spondylitis, it's not
possible to prevent the disease. However, being aware of any personal risk
factors for the disease can help in early detection and treatment. Proper and
early treatment can relieve joint pain and help to prevent or delay the onset of
physical deformities.

Self-care
If you smoke, quit. Smoking is bad for your health, but creates additional
problems for people with ankylosing spondylitis. Depending on the severity of
your condition, ankylosing spondylitis can affect the mobility of your rib cage.
Damaging your lungs by smoking can further compromise your ability to
breathe.

Coping skills
The course of your condition may change over time, and you may experience
relapses and remissions throughout your life. But despite the potential
complications, most people are able to live productive lives despite a diagnosis
of ankylosing spondylitis.
You may want to join a support group of other people with this condition, in
order to share experiences and support. Contact your local office of the
Spondylitis Association of America or the Arthritis Foundation to see if there are
any groups in your area or if you can start your own.

Spondylitis
From Wikipedia, the free encyclopedia
Spondylitis is an inflammation of a vertebra. Any disorder of the spinal column
may be called spondylopathy, also.
What is spondylitis?
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-low-are-throp-ah-thee). These diseases are forms
of inflammatory arthritis that primarily affect the spine, although other joints
and organs can become involved. The group of diseases in the spondylitis family
includes[1]:

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 joints, although other joints can
become involved. Occurring primarily in young adults, (age of onset normally
before age 35), AS causes inflammation of the spinal joints (vertebrae) that can
lead to severe, chronic pain and discomfort[2].
Undifferentiated spondyloarthropathy (USpA) - Undifferentiated
Spondyloarthropathy (USpA) is a term used to describe symptoms and signs of
spondylitis in someone who does not meet the criteria for a definitive diagnosis
of AS or related disease. Over time, some people with USpA will develop a welldefined form of spondylitis such as ankylosing spondylitis [3].
Juvenile spondyloarthropathy (JSpA) - Juvenile-onset spondyloarthritis (JSpA),
also known as Juvenile Spondyloarthropathy, is the medical term for a group of
childhood rheumatic diseases, which cause arthritis before the age of 16 and
may span through adult life. JSpA typically causes pain and inflammation in the
joints in the lower part of the body, for example, the pelvis, hips, knees and
ankles[4].
Psoriatic arthritis (PsA) - In 5-10% of those with psoriasis, arthritis also appears.
In most cases, the psoriasis will precede the arthritis, sometimes by many
years. When arthritis symptoms occur with psoriasis, it is called psoriatic
arthritis (PsA[5]).
Reactive arthritis (ReA) - Reactive Arthritis (also known as Reiter's Syndrome) is
a form of arthritis that can cause inflammation and pain in the joints, the skin,
the eyes, the bladder, the genitals and the mucus membranes. Reactive
arthritis is thought to occur as a "reaction" to an infection that started
elsewhere in the body, generally in the genitourinary or gastrointestinal tract [6].
Enteropathic arthritis - Enteropathic (en-ter-o-path-ic) arthritis is a form of
chronic, inflammatory arthritis associated with the occurrence of an
inflammatory bowel disease (IBD), the two best-known types of which are
ulcerative colitis and Crohn's disease. The most common areas affected by
enteropathic arthritis are inflammation of the peripheral (limb) joints, as well
as the abdominal pain and possibly bloody diarrhea associated with the IBD
component of the disease[7].

Pott's disease - a form of spondylitis that is the result of extrapulmonary

tuberculosis.