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0% needed o take their anti-rheumatic medications daily. In the past some people with AS used o get so

sooped that they could not even look straight ahead. Some forward sooping l the neck and curvature in the upper
back is still commonly observed after many years l the disease. Looking physically different from the rest l the
population can present psychological problem, but most people are able o come o terms with this. Severe disease
that results in complete spinal fusion in bent position and severe limitation l chest expansion, especia lly when there is
also contracture l the hip or shoulder joints, may shorten life span because the function l the heart and lungs may
be adversely affected and there is a greater risk l spinal fractures. Health-related quality l life. Health-related quality
l life is based on your perception l the net effects an illness has on your life. It is commonly based on your sympoms,
physical functioning and ability o work, psychosocial functioning and interaction, unoward effects l treatments, and
direct and indirect medical and financial costs. Although people with AS are troubled with pain, stiffness, and limited
spinal mobility, most l them remain in employment. A recent study at a rheumaology refe rral center in Germany
indicates that people with AS have a degree l pain, disability, and reduction in well-being similar o patients with
rheumaoid arthritis, a more severe CH 2 H C CH3 CH3 l arthritis. However, such referral centers are likely o see
patients with more severe disease, so their results many not apply o everyone with AS. In a recent survey l 175 AS
patients (68% male, mean disease duration l 23.7 years, mean age 51 years) the most common quality l life concerns
were about stiffness (90%), pain (83%), fatigue (62%), poor sleep (54%), appearance (51%), side-effects l medications (41%),
and concern about the future (50%). Few patients in this survey reported problems with social relations or mood. There
are many recently published journal articles on employment, disability and quality l life l patients with AS. S ee
'References and further reading section. Depression Depression is not uncommon in people with any chronic painful
illness that impairs quality l life, and that includes AS. Depression is a treatable disease that has many underlying
causes, and some individuals are genetically prone o it. Sympoms l depression include: loss l pleasure in activities
that were once enjoyable persistent feeling l sadness, emptiness, decreased energy, tiredness, and anxiety frequently
feeling helpless, worthless, guilty, and hopeless, or feeling irritable and restless disturbed appetite (loss l appetite or tendency
o overeat) disturbed sleep (difficulty sleeping, waking up oo early, oversleeping, sleeping oo little or oo much) difficulty in
concentrating, thinking, remembering, or decision-making sometimes persistent physical problems (e. g. headache,
abdominal pain) not responding o treatment thoughts l ending life by committing suicide. If you have any l these
sympoms you should discuss them with your docor so that appropriate treatment can be provided. Additional
information on depression is available from the National Institute l Mental Health (www.nimh.nih.gov) or the American
Psychiatric Association (www.psych.org). 12 The management l AS: an overview. There is currently no preventive
measure or a curative treatment for AS, but in most people the disease can be very we ll managed. Early and more
precise diagnosis leads o earlier and more rational or effective therapeutic interventions. Splints, braces, and corsets
are generally not helpful and are not advised. There is no special diet, and there is no evidence that any specific f ood
has anything o do with triggering or increasing the severity l AS. Fertility, pregnancy, and childbirth are usually
normal in women