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Ankylosing spondylitis

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Overview of ankylosing spondylitis

Ankylosing spondylitis is a disorder that causes inflammation of the joints between the bones of the spine and the joint between the spine and the pelvic bone. This long-term (chronic) disorder of the joint, eventually results in fusion of the opposing bones in the affected joint, if left untreated.

Ankylosing spondylitis affects about 0.1–2% of the population worldwide and is about three times more common in men than women. The condition is commonly noted to affect individuals between the ages of 15 and 35 years.

Dull back pain that may radiate to the buttock region is the initial symptom noticed in a typical case of ankylosing spondylitis.1

Signs and Symptoms of ankylosing spondylitis

Ankylosing spondylitis is initially characterized by the disturbing onset of pain in the back region during late adolescence. The pain may also be noted in the buttock region.

It may be associated with stiffness of the back in the mornings, which persists for a few hours. Daily activities tend to reduce the stiffness, which may return when the individual rests. Within a few months, the pain may become persistent and become worse at night times. The affected joints may be painful to touch and Other joints of the lower legs may display features of inflammation.

In advanced cases, the back pain may be associated with stiffness and pain in the neck.1,2 

At times, the affected individuals may also suffer from exhaustion, loss of appetite and mild fever. Infection of the eye, which is associated with pain, redness, blurring and sensitivity to light may also be noted. The heart and the lungs may be affected in chronic cases.1

Causes of ankylosing spondylitis

The presence of a specific tissue component known as HLA-B27 has been increasingly noted in individuals with ankylosing spondylitis.

This fact has led to the theory that the condition is hereditary. However, merely the presence of HLA-B27 in individuals does not indicate that the individual is sure to be affected. Factors such as environmental stresses seem to have a role in initiating the disorder in such individuals.

Frequent infection of the bowel or urinary tract may also be the triggering factor.

This disorder mainly affects the areas of the bones where the tissues and other structures that constitute the joint get attached.

One initiated the disorder results in inflammation in these areas, which is followed by a series of cell reactions that eventually results in replacement of the soft-tissues of the joints by bone.2

Risk Factors for ankylosing spondylitis

The risk factors that have been proposed to be associated with an increased incidence of ankylosing spondylitis include family history of the condition, male gender and frequent infections of the gastrointestinal tract.1,2

Diagnosis of ankylosing spondylitis

The diagnosis is mainly based on the family history of ankylosing spondylitis in the affected individual, the signs and symptoms noted and radiological findings. The typical history of early age of onset of the symptoms, morning stiffness that improves with activity and back pain for more than 3 months is generally suggestive of the condition.

Although the laboratory tests reveal the presence of the HLA-B27 antigen, it is not considered to be conclusive.

Radiographs may display the bony changes based on the stage and severity of the condition.1, 2

Treatment of ankylosing spondylitis

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The initial treatment of ankylosing spondylitis involves administration of simple painkillers that are available as over-the-counter medications. These medications, which belong to the group of drugs such as ibuprofen, aceclofenac, diclofenac sodium and valdecoxib are known to provide rapid relief from the back pain.

If the pain does not subside with these medications, a second-line of medications known as sulfasalazine may be prescribed for a certain period of time. Other medications that are being prescribed in refractive cases include methotrexate and steroid injections to the affected joint or joints.1, 2

A new group of drug known as tumour necrosis factor-alpha (TNF-alpha) inhibitors is being studied recently and has been noted to improve the symptoms along with a potential of modifying the disease progression.1,2,3

Alternative Therapies for ankylosing spondylitis

The alternative therapies are considered as an important adjunct to the medications being administered. Educating the individual about the condition, minor physical exercises, home exercises such as stretching of the spine and corrections of the posture are some of the additional therapies advised.1 These must be followed under proper guidance from the doctor.

Complications of ankylosing spondylitis

Fracture of the spine is the most serious complication associated with ankylosing spondylitis. Chronic cases may be associated with disorders of the heart and lungs. 2

Prevention of ankylosing spondylitis        

There are no known methods to prevent ankylosing spondylitis although the occurrence of complications can be prevented with early diagnosis and prompt treatment.

Living with Ankylosing Spodylitis

Ankylosing spondylitis is a chronic condition with symptom free period for long durations and occasional recurrence of pain in the joints. The ability to perform day–to- day activities is generally not hampered in most of the cases.

Living with ankylosing spondylotis

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References:

1.Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. 2004; 69(12): 2853–2860.

2.Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: An overview. Ann Rheum Dis. 2002; 61(Suppl III): 8–18.

3.Sieper J, Rudwaleit M. How early should ankylosing spondylitis be treated with tumour necrosis factor blockers? Ann Rheum Dis. 2005; 64(Suppl 4): 61–64.

Written by: healthplus24.com team

Date last updated: December 11, 2014