Ankylosing Spondylitis

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is an inflammatory condition that affects the joints in your
spine. Spondylitis simply means inflammation of the spine.

As part of the body's reaction to inflammation, calcium is laid down where the ligaments
attach to the bones that make up the spine (vertebrae). This reduces the flexibility of
your back and causes new bone to grow at the sides of the vertebrae. Eventually the
individual bones of the spine may link up (fuse). This is called ankylosis and can be
seen on x-rays.

Ankylosing spondylitis typically starts in the joints between your spine and pelvis, but it
may spread up your spine to your neck. It can sometimes affect other parts of the body,
including your joints, tendons or eyes.

Ankylosing spondylitis varies from person to person – your symptoms might be so mild
that you can almost forget you have the condition, but if they’re more serious it could
have a big impact on your quality of life.
 Who gets ankylosing spondylitis?
Ankylosing spondylitis can affect anyone, although it's most common in young men and most
likely to start in your late teens or 20s.

The genes you inherit from your parents may make you more likely to develop AS, but the
condition isn’t passed on directly. Most people with ankylosing spondylitis have a gene called
HLA-B27, which can be detected by a blood test. This gene isn't the cause of ankylosing
spondylitis but it does contribute to it.

Having this gene doesn’t mean you’ll definitely get AS, and the blood test isn't very useful in
diagnosing the condition. Even in families where somebody's been diagnosed with ankylosing
spondylitis there may be brothers or sisters who have the HLA-B27 gene but who don't have the
condition.

Versus Arthritis has recently awarded grants for a project which will aim to understand how
genes combine to cause AS and find out how alterations in gene regulators influence AS.
 Symptoms

In the early stages, ankylosing spondylitis and the related conditions are likely to cause:
 stiffness and pain in the lower back in the early morning which eases through the day or
with exercise
 pain in the sacroiliac joints (the joints where the base of your spine meets your pelvis),
in the buttocks or the backs of your thighs.
Some people first notice problems after a muscle strain, so the condition is often
mistaken for common backache. However, stiffness that lasts at least 30 minutes in the
morning helps to distinguish ankylosing spondylitis from simple back pain. The
symptoms may also occur after rest, or may wake you in the night.
You may also have neck, shoulder, hip or thigh pain, which is often worse if you've been
inactive for a time, for example if you work at a computer. Some people have pain,
stiffness and swelling in their knees or ankles. In psoriatic arthritis, the smaller joints of
the hands and feet may be affected. For some people, especially children and
teenagers, the first signs may be in their hip or knee rather than their back.
Inflammation can occur anywhere in the body where tendons attach to bone (this is
called enthesitis), for example, at the elbow and heel. Inflammation comes and goes so
the symptoms may vary over time.
The inflammation that causes these symptoms comes and goes, so the degree of pain
can vary over time and from person to person. If the condition is mild and only affects
the sacroiliac joints, it may go almost unnoticed, but if most of the spine is affected it
can cause difficulty with activities that involve bending, twisting or turning.
Other possible symptoms include:
 tenderness at the heel – This makes it uncomfortable to stand on a hard floor.
Inflammation can occur at the back of your heel where the Achilles tendon meets the
heel bone, or in the tendon in the arch of the foot which is known as plantar fasciitis.
 pain and swelling in a finger or toe – When the whole digit is swollen it’s known as
dactylitis.
 tenderness at the base of your pelvis (ischium) – This makes sitting uncomfortable.
 chest pain or a ‘strapped-in’ feeling that comes on gradually – If your spine is affected at
chest level (the thoracic spine) it can affect movement at the joints between the ribs and
the breastbone, which makes it difficult for you to take a deep breath. Your ribs may be
very tender, and you may feel short of breath after even gentle activity. Coughing or
sneezing may cause discomfort or pain.
 inflammation of the eye (uveitis or iritis) – The first signs of this are usually a red
(bloodshot), watery and painful eye, and it may become uncomfortable to look at bright
lights. If this happens, or if you develop blurred vision, it's important to get medical help
within 24–48 hours. The best place to go is an eye casualty department – this might not
be at your local hospital. Your GP surgery, local A+E or your optician will know where
the nearest eye casualty department is. Treatment is usually with steroid eye drops,
which are generally very effective. Some people get repeated attacks of eye
inflammation, but they're extremely unlikely to cause permanent damage if they're
treated promptly.
 inflammation of the bowel – People with ankylosing spondylitis can develop bowel
problems known as inflammatory bowel disease (IBD) or colitis. Tell your doctor if you
have diarrhoea for more than 2 weeks or begin to pass bloody or slimy stools. You
might be referred to a bowel specialist (gastroenterologist). Symptoms of IBD can vary,
but it can usually be treated successfully with medication. Sometimes treatments
like non-steroidal anti-inflammatory drugs (NSAIDs) can make bowel problems worse,
so you might be advised to stop taking them.
 tiredness (fatigue) – This may be caused by the activity of the condition, anaemia or
sometimes depression and frustration associated with the condition.

Treatment
A number of treatments are available that can ease pain and stiffness, but exercise and
close attention to your posture are just as important to keep the spine mobile and help
you to live a normal life.

Painkillers (analgesics) and non-steroidal anti-inflammatory drugs (NSAIDs) are

usually the first choice of treatment, and most people with ankylosing spondylitis will
need to take these at times.
Painkillers such as paracetamol or co-codamol are often very helpful. They can be
taken regularly and are particularly useful just before activity to keep your pain to a
minimum. It's best not to wait until you're in severe pain before taking them. They don't
need to be taken with a meal, though some water and a small snack are advised.

There's a wide range of NSAIDs that can reduce pain so you can get on with your daily
activities and your exercise routine. You'll probably need to take these during bad
patches, and some people may need them over a longer period. Some tablets are made
in a slow-release formulation, which can help with night-time pain and morning stiffness.
Some NSAIDs are also available as gels, which you can apply to the painful area.
Physical therapies
Physiotherapy is a very important part of the treatment for ankylosing spondylitis. A
physiotherapist can put together a programme of exercises that increase your muscle
strength and help you maintain mobility in your spine and other joints. It’s especially
important to exercise your back and neck to avoid them stiffening in a bent position.
A physiotherapist will advise you on how to maintain good posture and may also be able
to offer you hydrotherapy, which involves special exercises in a warm-water pool. Many
people with AS find this therapy helpful and continue their programme at their local
leisure pool or with a National Ankylosing Spondylitis Society (NASS) group.
Surgery
Most people with ankylosing spondylitis don’t need surgery, although some may need
a hip or knee replacement if these joints are badly affected. This can get rid of pain and
improve mobility. Surgery to straighten a bent spine is very rare and isn’t usually
recommended. You should speak to your rheumatologist about referral to an
experienced spinal surgeon if you want advice on this.

Nechita Claudiu

Anul III ,Sem 2 ,

KMS