Health
Problems
Ankylosing Spondylitis
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What
is Ankylosing Spondylitis?
Ankylosing
spondylitis (AS) - also known as Marie-Strumpell's Disease - is an
inflammatory arthritic condition of the spine and sacroiliac joints. The
hallmark of this disease is bony fusion (known as "ankylosis")
of the spinal vertebrae which leads to a permanent loss of flexibility of
the back and neck. Other large joints and connective tissues may also be
affected by the inflammatory process. AS tends to affect adult men between
the ages of 20 to 40i; the disease is rare after age 50. Women make up
only a small minority of the patients.
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Known causes
The exact cause
of AS still eludes medical investigators. Genetic factors are thought to
be important. Approximately nine out of ten persons with this disease have
a specific tissue type known as HLA-B27, but as only one in five persons
with HLA-B27 actually develops AS, environmental factors and dietary
habits must also be contributory to the onset of AS. Current medical
thinking is that AS may be the result of an exaggerated and prolonged
immune response (similar to Rheumatoid Arthritis) likely to have come from
a previous infection and that this immune response leads to chronic
inflammation in susceptible individuals.
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Signs and
Symptoms
Pain and stiffness is often first localized to the low back and the
sacroiliac joints . The discomfort tends to be more severe in the morning,
and reduces with daily activity. Aches and pains may also affect the hip,
shoulder and neck.
With time the inflammatory process
gradually moves upward to involve the upper back (thoracic spine) and then
the cervical vertebrae (neck) as well as the joints of the thorax (ribcage
and breastbone). Fever, fatigue, inflammatory bowel disease, weight loss
and low blood counts may also accompany the sym ptoms of AS. In severe
cases, the inflammation and pain, which occur intermittently over the
years, finally begin to subside as the vertebrae slowly fuse together. The
spinal column becomes straight and rigid ( as a "poker
spine") losing its normal curvature. By this time, the patients walk
stiffly and bent-over. They find it difficult to breathe deeply because
they are not able to fully expand their ribcage. Anterior uveitis, a
specific type of eye inflammation, affects about one out of four patients,
while leakage of the aortic valve of the heart, one of the most serious
complications of AS, is relatively rare.
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Evaluation
and Diagnosis
Tenderness over the lower back and sacroiliac joints is the common
indication used in diagnosis. In chronic cases, loss of spinal
flexibility, spinal deformity and decreased chest expansion are evident.
Early in the course of the disease, X-rays of the spine and pelvis may be
normal; however, as the inflammatory process continues characteristic
changes occur in the sacroliac joints and spine. Fusion is seen as bony
bridges between the vertebrae called syndesmophytes. The spinal X-ray
looks like a bamboo.
It should also be noted that AS is often
difficult to differentiate from other types of arthritis that affect the
spine: Reiter's syndrome, and the arthritic conditions associated with
psoriasis and inflammatory bowel diseases (ulcerative colitis). When
joints in the extremities are affected more than the spine, blood tests
can be used to exclude rheumatoid arthritis.
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Conventional
Treatment
Patients are encouraged to participate in a regular program of breathing
exercises and physical therapy to help maintain chest mobility and back
flexibility. In addition, they are advised to keep an upright posture and
to sleep on a hard mattress. The non-steroidal anti-inflammatory
medications, phenylbutazone and indomethacin, can help control pain, but
they have no direct effect on the course of the disease. Operations to
correct bony deformities are sometimes recommended, but severe limitations
of spinal movement and chest expansion place these individuals at risk for
complications from general anesthesia.
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This page was last updated on 04 December 2006 21:11:30
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