Dr. M.J. Bazos,
WHAT IS ANKYLOSING
(AS) is a rheumatic disease that causes arthritis of the spine and sacroiliac
joints and can cause inflammation of the eyes, lungs, and heart valves. It
varies from intermittent episodes of back pain that occur throughout life to a
severe chronic disease that attacks the spine, peripheral joints and other body
organs, resulting in severe joint and back stiffness, loss of motion and
deformity as life progresses.
AS is a
member of the family of diseases that attack the spine called
spondylarthropathies. In addition to AS, these diseases include Reiter’s
syndrome, some cases of psoriatic arthritis and the arthitis of inflammatory
cause of AS is not known, but all of the spondylarthropathies share a common
genetic marker, called HLA-B27, in most affected individuals. In some cases, the
disease occurs in these predisposed people after exposure to bowel or urinary
- AS afflicts an estimated 129 out of 100,000
people in the United States.
- AS typically strikes adolescents and young adult
- The prevalence of AS varies by ethnic group and
is most common in Native Americans.
diagnosis is common because symptoms are often attributed to more common back
problems. A dramatic loss of flexibility in the lumbar spine is an early sign of
AS. Although most symptoms begin in the lumbar and sacroiliac areas, they may
involve the neck and upper back as well. Arthritis may also occur in the
shoulder, hips and feet. Some patients have eye inflammation, and more severe
cases must be observed for heart valve
involvement.At times, AS may presage
the development of inflammatory bowel disease, and some patients have fever,
fatigue, weight loss, anemia, eye inflammation (called iritis), and more severe
cases may involve heart valve dysfunction. Other disorders of the internal
organs and bones mimic spondylarthropathies and must be distinguished.
Laboratory evaluation may reveal an elevated sedimentation rate (an indicator of
inflammation), anemia and a positive HLA-B27 assay. X-rays and bone scans may
show characteristic changes.
severity of joint involvement and the degree of systemic symptoms vary greatly
from one individual to another. Early, accurate diagnosis and therapy may
minimize years of pain and disability.
Medical treatment consists of
nonsteroidal anti-inflammatory medications. Indomethacin is most effective,
while sulfasalazine may benefit those with more severe involvement. Peripheral
joint arthritis may respond to methotrexate.
Rehabilitation therapies are
essential. Proper sleep and walking positions, coupled with abdominal and back
exercises, help maintain posture. Exercises help maintain joint flexibility.
Breathing exercises enhance lung capacity, and swimming provides aerobic
exercise. Even with optimal treatment, some people will develop a stiff or
"ankylosed" spine, but they will remain functional if this fusion occurs in an
upright position. Continuing care is critical. AS is a lifelong problem, and
people often fail to continue treatment, in which case permanent posture and
mobility losses occur.Web