Ankylosing Spondylitis.
Last updated Friday, February 11, 2005
AboutBasics of ankylosing spondylitis Ankylosing spondylitis primarily affects the spine or back. In a person
with ankylosing spondylitis, 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. Other joints such as the hips, shoulders, knees, or ankles
also may become involved.Prognosis Almost all people with ankylosing spondylitis can expect to lead
normal and productive lives. Despite the chronic nature of the illness,
only a few people with ankylosing spondylitis will become severely
disabled. The management of pain and the control of inflammation can
reduce the daily problems that may occur with ankylosing spondylitis.
By watching posture and body position and by doing exercises daily, the
individual can control many of the effects of the disease.
Ankylosing spondylitis is rarely crippling and the symptoms can be
managed in most people. Keep in mind that each person with ankylosing
spondylitis responds to treatment differently; what works for another
person may not work for you. Be patient and actively participate in
your care. Even though a cure is not known at present, you can do a lot
on your own to control your symptoms. Lethality Ankylosing spondylitis is not a fatal condition.Fertility and pregnancy Pregnancy
in women with ankylosing spondylitis does not usually involve any
special problems for mother or baby. However, some medications can be
harmful to unborn children. If you are pregnant or planning to become
pregnant, you will need to discuss the use of medication with your
doctor.Incidence Symptoms of ankylosing spondylitis appear most frequently in young
men between the ages of 16 and 35. It is less common in women, whose
symptoms are often milder and more difficult to diagnose.
About five percent of ankylosing spondylitis begins in childhood;
boys are more likely to have it than girls. When children develop
ankylosing spondylitis, it usually begins in the hips, knees, bottoms
of heels, or big toes and may later progress to involve the spine.
The gene is present in eight percent of healthy white Americans and
two to three percent of healthy African Americans. About 300,000
Americans (less than one percent of the adult population) have
ankylosing spondylitis. The disease is three times more common in
whites than in African Americans. Acquisition Heredity seems to play a role in determining who gets ankylosing
spondylitis.: approximately one in five people affected by ankylosing
spondylitis have a relative with the same disorder. A genetic "marker"
called HLA-B27 is present in most people who have AS. However, most
people (about 80%) who test positive for the marker never develop the
disease. What "triggers" the disease in those patients who may be
susceptible to it (i.e. patients who test positive for HLA-B27) is not
well understood.Anatomy
Ankylosing spondylitis is a systemic disease, meaning it can affect the
entire body in some people. It can cause fever, loss of appetite, and fatigue, and it can damage other organs besides the joints, such as the lungs, heart, and eyes. Most often though, only the low back is involved.
The eye is the most common organ affected by ankylosing spondylitis.
Eye inflammation (iritis) occurs from time to time in one-fourth of
people with ankylosing spondylitis. Iritis results in a red, painful
eye that also leads to photophobia, increased pain when looking at a
bright light. It is a potentially serious condition requiring medical
attention by an ophthalmologist. Luckily, it rarely causes blindness
but it can affect vision while the inflammation is present.
Less frequently, ankylosing spondylitis may be associated with a scaly skin condition called psoriasis.
In rare cases, typically when the ankylosing spondylitis has been
present for many years, ankylosing spondylitis may cause problems with
the heart or lungs. It can affect the large vessel called the aorta
that moves blood from the heart into the body. Ankylosing spondylitis
can cause inflammation where the heart and aorta connect leading to
possible enlargement of the aorta.
Symptoms similar to that seen in ankylosing spondylitis may also may occur along with such conditions as psoriasis, inflammatory bowel disease, or Reiter's syndrome.
It is thought that bowel inflammation is somehow tied to the
development of ankylosing spondylitis and this is the reason that
people with inflammatory bowel disease, i.e. Crohn's disease or
ulcerative colitis are at an increased risk of the illness.
Symptoms The inflammation in ankylosing spondylitis usually starts around the
sacroiliac joints, areas where the lower spine is joined to the pelvis.
The pain associated with ankylosing spondylitis is worse during periods
of rest or inactivity. People with ankylosing spondylitis often awaken
in the middle of the night with back pain. Typically, symptoms lessen with movement and exercise.Progression Over a period of time, pain and stiffness may progress into the upper
spine and even into the chest and neck. Ultimately, the inflammation
can cause the sacroiliac and vertebral bones to fuse or grow together.
When this occurs, the normal flexibility of the spine, including the
neck, is lost and the whole spine becomes rigid. Similarly, the bones
in the chest may fuse, causing a loss of normal chest expansion when
breathing. The hips, shoulders, knees, or ankles also may become
inflamed and painful and eventually lose their mobility. if these joints are damaged to the point where daily activities become compromised or very painful, it is often possible to surgically reconstruct those joints with total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty. The heels may
become affected, making it uncomfortable to stand or walk on hard
surfaces.Diagnosis Doctors usually base their diagnosis of ankylosing spondylitis on
symptoms (pain, stiffness) and X-rays showing inflammation of the
sacroiliac joints at the back of the pelvis.Diagnostic tests If your symptoms or X-rays suggest ankylosing spondylitis, but the
diagnosis is uncertain, your doctor may perform a blood test to check
you for the HLA-B27 gene. About 90 percent of people diagnosed with
ankylosing spondylitis do test positive for this gene.Treatment Treatment for ankylosing spondylitis should be designed to reduce
pain and stiffness, prevent deformities, and help you maintain your
normal activities.
The basics of treatment include:
- Education
- Attention to posture
- Exercise
- Medications
Should these approaches fail to provide adequate relief and should the spine, hips, knees or shoulders become damaged or painful, there are a number of reconstructive surgical procedures available, including spine surgery, total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty. Health care team
You should choose a doctor experienced in treating arthritis. Your
doctor will work with you to decide when you need the help of other
health professionals, such as physical or occupational therapists.
Effective treatment of ankylosing spondylitis relies on a partnership between you and your care providers. Exercise and therapy
Regular exercise is an essential part of the overall management of
ankylosing spondylitis. Your physical therapist with arthritis
experience can design a program of exercises
to meet your needs. Exercises that strengthen the back and neck will
help maintain or improve your posture. Deep breathing exercises and
aerobic exercises will help keep the chest and rib cage flexible.
Swimming is an excellent way to exercise since it promotes flexibility
of the spine; movement of the neck, shoulder, and hip joints; and deep
breathing.
If you sometimes feel too stiff and sore to exercise, try
taking a hot bath or shower to loosen up. Begin your exercises slowly
and plan to do them when you are the least tired or have the least
pain.
Whether your overall medical
condition would permit an exercise regime would be a good topic for you
to discuss with your internist, family doctor, or rheumatologist. The
initiation of a fitness program in someone who has never participated
in one before certainly should be done under the guidance of a
physician or physical therapist.
Physical therapy is not believed to prevent progression of AS, but it may minimize symptoms in some patients.
Posture
Make every effort to keep your spine straight. Sleep on a hard
mattress. Try to sleep on your stomach without a pillow under your
head. You also can try sleeping on your back with a thin pillow or one
that supports the hollow of your neck. Keep your legs straight rather
than sleeping in a curled position. If you find it difficult to sleep
in these positions, talk to a physical therapist about other possible
options.
When walking or sitting, keep your spine as straight as you
can with your shoulders squared and your head up. A test for correct
posture can be done by standing with your back against the wall; your
heels buttocks, shoulders, and head should be able to touch the wall
all at once. Be sure that chairs and work surfaces are designed so that
you don't slump or stoop.
Corsets and braces, in general, are of little value in
treating ankylosing spondylitis. You are much better off maintaining
good posture by exercising properly.
Medications Medication is
usually an essential and ongoing part of treatment. While medications
do not cure ankylosing spondylitis, they do relieve pain and stiffness,
allowing you to exercise, maintain good posture, and continue normal
activities.
Several types of medication help treat ankylosing spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs)
reduce inflammation and relieve pain. Typical NSAIDs include
indomethacin, piroxicam, or naproxyn. Side effects of NSAIDs include
stomach upset leg swelling and rarely ulcers or bleeding from the
stomach. Newer NSAIDs, known as the COX-2 inhibitors (rofecoxib,
celecoxib) may be able to relieve inflammation and painwith fewer side
effects. Aspirin has been found to be of little use in treating
ankylosing spondylitis. Higher doses of NSAIDs are usually required to
relieve the inflammation in addition to the pain.
A medication called sulfasalazine has been shown to reduce the
inflammation and symptoms of ankylosing spondylitis, but it is not
known whether sulfasalazine may slow or halt the progression of the
disease. Some of the new medications that affect an inflammatory
substance called TNF are being investigated as possible agents that may
affect the course of theillness.
Whichever medications your doctor prescribes for you, be sure to take
them as directed, even when you seem to be feeling fine. Also, talk to
your doctor about possible side effects and what to do if they occur.
If your symptoms worsen, call your doctor.
Surgery Surgery
is a rare measure used in the management of ankylosing spondylitis.
Joint replacement surgery is enabling many people to regain the use of
joints that have been affected by ankylosing spondylitis and other
forms of arthritis. Hip, knee, and shoulder replacements can be
successful in ankylosing spondylitis. Rarely surgery can be done to
straighten the spine but requires a significant expertise and should
only be done by those with experience in the this area.Strategies for coping People who develop a chronic illness such as ankylosing spondylitis learn over time to cope with emotional ups and downs.
Learning to cope with ankylosing spondylitis often requires
accepting changes. You may need to make changes in your relationships,
work habits, and leisure-time activities. You may have to deal with
changes in your appearance. All of these possible changes may leave you
sad, stressed,
depressed, or angry. Sometimes it helps to talk about these feelings
with a family member, close friend, counselor, or someone else who has
ankylosing spondylitis.
Asking for help
There may be times when you and your family are faced with problems
caused by your disease that you do not know how to solve. You might
want to talk to a counselor who has experience working with people who
have arthritis. If so, your doctor probably can recommend one. It also
may help to get to know other families who are living and coping with
ankylosing spondylitis.
There are several organizations devoted to educating and supporting people with ankylosing spondylitis. One of these is the Spondylitis Association of America.
In addition, to find a rheumatologist (physicians who specialize in
treatment of spondylitis) or to learn what is new in the understanding
or treatment of ankylosing spondylitis, contact the American College of Rheumatology.
Work
The majority of people with ankylosing spondylitis are able to continue a productive, active work
schedule. Whether you work in or outside the home, the following
suggestions may help. It may be helpful to discuss your work with your
rheumatologist.
If your current job involves prolonged stooping or excessive strain on your back, you may want to contact a vocational rehabilitation
agency in your state for guidance. The agency also may be able to help
you if your experience, education, or training make it difficult for
you to change jobs.
Family and friends
Most forms of arthritis do not limit one's ability to enjoy romantic and sexual relationships.
From time to time, however, problems such as pain and limited
movement--especially of the hip joint--may get in the way of sexual
enjoyment. Some extra planning may be all that's needed.
One of the most important aspects of a good sexual relationship is
good communication. If you and your partner can comfortably discuss
each other's needs, you probably can overcome almost any difficulty.
Adaptive aids
If some of your joints have fused or if you already have limited joint
mobility, you may find it helpful to use some adaptive equipment or
self-help aids. For instance, long-handled shoehorn or sock aids can
help if your back or hips don't bend easily.
When driving, always wear a seat belt with a shoulder harness and
have the headrest in your car adjusted to support your neck. If a stiff
neck or back makes backing into parking spaces difficult, try fitting
your car with extra-wide mirrors.
Because your neck and spine may be hurt easily, avoid activities
that could cause falling or produce a sudden impact. Talk to your
doctor or occupational therapist about ways to avoid injury and ways to
improve your ability to function.
Credits Some of this material may also be available in an Arthritis Foundation
brochure. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK, contact the National
Helpline: (800) 283-7800.
Adapted from the pamphlet originally prepared for the Arthritis
Foundation by Frank C. Arnett, M.D. Professor of Internal Medicine,
University of Texas Medical School at Houston. This material is
protected by copyright.
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