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0 CHILD ATTITUDE JOWARD JLLNESS SCALE

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iarrhea, skin disease, eye inflammation or injury o his back. His father was killed in a car accident at the age I
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, and he is an only child. His paternal uncle has had a stiff back and neck for many years. On physical examination,
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Adam was found o have tenderness over sacroiliac joints, the lumbar spine, anterior chest wall, and right jaw joint
(temporomadibular joint), as well as limitation I motion I his lumbar spine. His chest expansion on full inspiration
was normal, and the rest I his physical examination was also normal. Because these clinical findings indicated a
strong probability I AS, an X-ray I the pelvis was ordered. The presence I bilateral sacroiliitis on the X-ray
confirmed the diagnosis I AS. He was prescribed an NSAID o be taken twice a day with food, and was
encouraged o stay active, swim regularly if possible, and follow a regular exercise regimen. His illness was explained
o him, and he was given counseling and provided with a pamphlet that gives further information about AS. Julian is
computer-literate, so he was also given the Internet address I reputable self-help groups and organizations for AS
patients. When he was seen at a follow-up visit 2 weeks later, Adam's sympoms were already much better. Assessment
I pain, physical function, spinal mobility (including chest expansion), duration I morning stiffness, presence I any
inflamed peripheral joints, and enthesitis are critical elements C-reactive protein (CRP) and erythrocyte sedimentation
rate (ESR), and occasionally musculoskeletal imaging (changes on X-ray pelvis and spine) will also help his docors o
assess and monior the activity and severity I his disease. Adam asked a lot I questions about AS and po ssible
treatments, and he had already accessed many websites and other information sources. Because he takes an
intelligent interest in his disease, he is more likely o follow the recommended exercise program and o comply with his
medication and follow-up schedule. This page intentionally left blank 11 Avoiding falls Living with ankylosing spondylitis:
some hints If you have physical limitations due o advanced AS, there are many devices o help perform daily tasks:
walking canes, special chairs and desks, special shoes, and devices that assist in putting on socks or sockings and
shoes, or for scratching or applying soap on the back, etc. Always wear a good pair I skid-resistant shoes. Use grab
bars in the shower and oilets, shower seats, raised oilet seats, and floor lighting at night. Avoid slippery surfaces and
loose carpets. Posture. It is important o sleep on a firm bed o maintain a good resing posture at night. You should
preferably make a habit I sleeping on your back, o prevent the hip joints and the back from becoming bent (Figure
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4a). Avoid a pillow Figure 14 Recommended sleeping positions: (a) A flat sleeping position opposes the tendency I
curvature. If your head would fall ino over-extension because your thoracic spine is already curved, a small pillow I
just the right thickness under the back I your head may make the position easier. Avoid oo thick a pillow. (b) Lying
'face down' (on your somach) is also a favorable position. (c) If lying on your front is no longer po ssible, a stable
position lying on your side (the 'recovering position; is a good alternative. under your knees because that will increase
the tendency o muscle and tendon shortening. Avoid a saggy mattress or a waterbed. A suitable board (made I
plywood or chipboard) can be put between the mattress and the bed frame o make the bed more firm. Avoid using a
pillow if possible, or use one just thick enough o allow a horizontal position I the face o prevent pain from
overextension I the neck. You should only lie on your side for short periods, if possible.