ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum meets the iliac bones. Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic inflammation (spondylitis) can lead to a complete cementing together of the vertebrae, a process called ankylosis. This also causes total loss of mobility of the spine. AS is also a systemic rheumatic disease. Therefore, it can cause inflammation in other joints away from the spine, as well as other organs, such as the eyes, heart, lungs, and kidneys.

The disease course is highly variable, and while some individuals have episodes of transient back pain only, others have more chronic severe back pain that leads to differing degrees of spinal stiffness over time. In almost all cases the disease is characterized by acute painful episodes and remissions. AS is a member of the family of diseases that attack the spine. These are named spondylarthropathies. In addition to AS, these diseases include Reiter’s syndrome, some cases of psoriatic arthritis and the arthritis of inflammatory bowel disease.

It affects between 150,000 and 300,000 Canadians (as many as 1 in 100)

Men develop ankylosing spondylitis three times more often than women.

It usually appears in people between the ages of 15 to 40.

About 5% of AS begins in childhood. When kids have AS, it begins in the hips, knees, or big toes and may later progress to involve the spine.

AS is three times more common in whites than in African Americans.

Frequent low back pain

Back stiffness that lasts longer than 30 minutes first thing in the morning of after a long period of rest.

Pain and tenderness in the ribs, shoulder blades, hips, thighs, shins, heels, and along the bony points of the spine,

In the early stages, there may be mild fever, loss of appetite and general discomfort.

The eyes can also be affected and symptoms can include eye pain, watery eyes, red eyes, blurred vision, and feeling sensitive to bright light.

Inflammation of the area where muscle inserts into the joint causing pain and tenderness.

Patient with ankylosing spondylitis complicated by rigid flexion deformity.

The exact cause is unknown. AS tends to run in families: approximately one in five people affected by AS have a relative with the same disorder. Just as we inherit our hair color and blood type from our parents, we also inherit our tissue type. The tissue typing system is the Human Lymphocyte Antigen (HLA) system. One of the tissue types, HLA-B27, is found in only 6% of the broad population but occurs in approximately 93% of individuals with AS. The HLA-B27 tissue type, while not causing AS, does predispose individuals with the B27 tissue type to developing AS. Thus we see AS tending to occur in families. Having the tissue type itself does not mean you will get AS, it simply increases the possibility. Identifying the activating agent that later triggers AS is the focus of much current research.

Almost all people with AS can expect to lead normal and productive lives. Despite the chronic nature of the illness, only a few people with AS will become severely disabled. The management of pain and the control of inflammation can reduce the daily problems that may occur with AS. Some ways to manage the pains and inflammation:

Medicine

The most common type of medicine used to treat AS is nonsteroidal anti-inflammatory drug (NSAIDs). These drugs help reduce the pain and swelling of the joints and decreases stiffness. However, they do not prevent further joint damage. Two common NSAIDS are Aspirin and Advil.

For those with severe disease who have inflamed joints, a drug called sulfasalazine can help manage the symptoms, and better control the disease.

Occasionally a cortisone injection into an affected joint or ligament brings short-term relief. Cortisone is a steroid that reduces inflammation and swelling.

If your eyes are affected, cortisone eye drops may also be prescribed.

Exercise

Exercise is one of the most important activities in managing AS. Exercise helps keep joints moving and reduce pain.

A physical therapist can teach you exercises to do daily. Range of motion exercises reduce stiffness and help keep your joints moving.

Other activities such as swimming, walking, and cross-country skiing also encourage good posture.

Heat/Cold

Applying heat helps relax aching muscles, and reduces joint pain and soreness.

Applying cold helps to lessen the pain and swelling in a joint.

Protect Your Joints

Be kind to your body. After doing heavy work, stop, and take a rest.

Sleep on a firm supportive mattress and support your neck with special neck supports or pillows.

Avoid the tendency to slump forward or slouch.

Relaxation

Relaxing the muscles around an inflamed joint reduces pain.

There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation tapes. Meditate or pray.

Surgery

You and your doctor may consider surgery, if one of your joints becomes badly damaged, or if the pain is too strong.

With AS the hip joints are quite often involved, and it can progress to where these joints are quite damaged. The end stage of this hip damage is often total hip joint replacement through surgery.

You have an important role to play in the early diagnosis and treatment of arthritis. Early treatment can mean less disability in the long run. If you have symptoms of arthritis, report them to your doctor. An examination, and sometimes x-rays and blood tests, will help your doctor to decide if you have AS. A treatment program can then be set up to reduce the pain and disability that AS can cause.