Ankylosing Spondylitis

Definition - Ankylosing spondylitis (AS) is an autoimmune disease which affects collagen structures, specifically the joints between the vertebrae of the spine and sacroiliac joints. The joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Complete fusion can result in a complete rigidity of the spine, a condition known as bamboo spine.  These changes may be mild or severe. Severe disease may lead to poor posture and deformities. Early diagnosis and treatment helps control pain and stiffness, and may reduce or prevent significant deformity.  

Signs and Symptoms - The typical patient is a young man of 15-30 years old with chronic pain and stiffness in the lower part of the spine. Males are affected by ankylosing spondylitis three times more than women. It is generally milder in women and more common in Caucasians than in African Americans. 

Younger patients may experience knee pain even at very young ages (3 years old), commonly misinterpreted as simple rheumatisms.
Patients may also have a fever, fatigue and loss of appetite.
Constant pain and stiffness in low back, buttocks and hips.
Fusion of the ribs to the spine or breastbone may limit a person's ability to expand his or her chest when taking a deep breath.
Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel.
Eye inflammation (redness) occurs in about one-fourth of patients with spondylitis. In rare cases, lung and heart problems may also develop. 
 
 
Diagnosis - There is no direct test to diagnose AS. A clinical examination and x-ray studies of the spine, which show characteristic spinal changes and sacrum changes, are the major diagnostic tools.  A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced.   An option for more accurate (and much earlier) diagnosis are tomography and magnetic resonance imaging of the sacroiliac joints. 

If symptoms or X-rays suggest ankylosing spondylitis but the diagnosis is uncertain, your doctor may perform a blood test to check for the HLA-B27 gene.

During acute inflammatory periods, AS patients will usually show an increase in the blood concentration of C-reactive protein (CRP) and an increase in the erythrocyte sedimentation rate (ESR), a measure of inflammation present. 

HLA-B27 - Variations of the HLA-B gene increase the risk of developing ankylosing spondylitis, although it is not a diagnostic test. Those with the HLA-B27 variant are at highest risk of developing the disorder. HLA-B27, demonstrated in a blood test, is occasionally used as a diagnostic, but does not distinguish AS from other diseases and is therefore not of real diagnostic value. Over 95% of people with AS are HLA-B27 positive, although this ratio varies from population to population (only 50% of African American patients with AS possess HLA-B27, and it is close to 80% among AS patients from Mediterranean countries).

Other areas that might be affected

In 40% of cases, ankylosing spondylitis it is associated with iridocyclitis (anterior uveitis) causing eye pain and photophobia (increased sensitivity to light).
AS is also associated with ulcerative colitis, psoriasis and Reiter's disease.
Osteopenia or osteoporosis of AP spine, causing eventual compression fractures and a back "hump" if untreated.
Organs affected by AS, other than the axial spine, are the hips, heart, lungs, heels, and other areas (peripheral).

How is AS treated? - No cure is known for AS, although treatments are available to reduce symptoms and pain. 

The goals of treatment are:

Reduce pain and stiffness
Eliminate inflammation
Maintain posture
Prevent deformity
Preserve's one ability to perform normal activities

Treatment to reduce the inflammation and pain are needed prior to physiotherapy and physical exercise.  This way the movements will help in diminishing pain and stiffness, while exercises in an active inflammatory state will just make the pain worse.

Almost all sufferers can expect to lead normal and productive lives. Despite the chronic nature of the illness, only a few people will become severely disabled; the management of pain and the control of inflammation can reduce the daily problems that may occur.  By watching posture and body position and by doing exercises daily, an individual can control many of the effects of the disease.