• *  What is ankylosing spondylitis?

    Ankylosing Spondylitis (AS) is a type of chronic inflammatory arthritis that affects spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine. AS affects men three times more often than women.The first symptoms of AS typically start in late adolescence. AS can cause inflammation or injury to other joints away from the spine, as well as to other organs, such as the eyes, heart, and lungs. AS can cause inflammation of the tendons surrounding the joints (enthesitis). Some of the common spots for enthesitis are the back of the heels (Achilles tendonitis), and underneath the bottoms of the feet (plantar fasciitis).

     

    What causes ankylosing spondylitis?

    The majority of people (90%) with AS have a gene called HLA-B27. The HLA-B27 gene appears only to increase the tendency of developing AS, while some factor(s), perhaps environmental, are necessary for the disease to become expressed. Not everyone with AS carries this gene; therefore, if your doctor tests you and you don’t have it you may still have AS.

     

    * What are ankylosing spondylitis symptoms?

    Fatigue is a common symptom associated with active inflammation. Inflammation of the spine causes pain and stiffness in the low back, and upper buttock area. The onset of pain and stiffness is usually gradual and progressively worsens over months. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. The pain is often eased by movement, heat, and a warm shower in the morning.

    Chronic spondylitis and ankylosis cause forward curvature of the upper torso. Spondylitis can affect the areas where ribs attach to the upper spine, further limiting lung capacity. AS can cause inflammation and scarring of the lungs, causing shortness of breath, especially with exercise and infections.

    How is ankylosing spondylitis diagnosed?

    There is no specific test to diagnose AS. The diagnosis of ankylosing spondylitis is based on evaluating the patient’s symptoms, a physical examination, X-ray findings, and blood tests. Symptoms include pain and morning stiffness of the spine and sacral areas with or without accompanying inflammation in other joints, tendons, and organs.

    These blood tests are called ESR (erythrocyte sedimentation rate) and CRP (C-Reactive Protein). Test for the HLA-B27 gene can be helpful. Finally, X-rays may be taken to determine if there are changes in the joints at the bottom of the spine (sacroiliac joints).

    What are treatment options for ankylosing spondylitis?

    The goal is to keep the spine flexible and the joints moving with the hope to prevent or delay permanent damage. Medications decrease inflammation in the spine and other joints and organs. Physical therapy and exercise help improve posture, spine mobility, and lung capacity.

    Disease-Modifying Anti-Rheumatic Drugs such as methotrexate and sulfasalazine can be used in combination with Non-steroidal anti-inflammatory drugs (NSAIDs) although they generally don’t work as well for inflammation in the spine. NSAIDs are commonly used to decrease pain and stiffness of the spine and other joints. Commonly used NSAIDs include indemethacin, naproxen and diclofenac.

    In AS, steroids are usually used for short durations to quickly relieve a flare of symptoms. They are usually injected into a joint or taken orally (prednisone).

    Newer, effective medications for spine disease attack a messenger protein of inflammation called tumor necrosis factor (TNF). These TNF-blocking medications have been shown to be extremely effective for treating ankylosing spondylitis by stopping disease activity and improving spinal mobility. Examples of these TNF-blockers include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi).

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