Ankylosing Spondylitis - Causes, Symptoms, Treatment
Ankylosing spondylitis (AS) is one of the many types of arthritis. “Ankylosing” means joining together or stiffening; “spondylitis” means inflammation of the vertebral bones of the spine. Inflammation of the bones in AS can lead to degeneration, pain, and loss of joint motion. AS typically affects the spine but can been seen in other areas, especially the hips. Ankylosing spondylitis can range from a mild to more severe disease in patients. Ankylosing spondylitis is approximately three times more common in males than females. It typically affects young people, beginning between the ages of 15 and 30. It may affect younger people also, although in very young people it may take a slightly different form, causing pain around the heels, knees, and hips rather than beginning with the spine. Onset after age 40 is uncommon.
Causes
Some people may just experience episodes of transient back pain. Others may experience long standing and severe back pain that leads to differing degrees of spinal stiffness. Almost always, the problem is characterized by acute painful episodes followed by periods when the pain settles.
The tendency to develop ankylosing spondylitis is believed to be genetically inherited, and the majority (nearly 90%) of patients with ankylosing spondylitis are born with the HLA-B27 gene. Blood tests have been developed to detect the HLA-B27 gene marker and have furthered our understanding of the relationship between HLA-B27 and ankylosing spondylitis.
Symptoms
Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse your vertebrae together, limiting movement. Symptoms can worsen or improve or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help.
Diagnosis
There is no direct test to diagnose AS. A clinical examination and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis, are the major diagnostic tools. A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray-evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced. Options for more accurate (and much earlier) diagnosis are tomography and magnetic resonance imaging of the sacroiliac joints.
Treatment
The severity of joint involvement and the degree of systemic symptoms vary greatly from one individual to another. Early, accurate diagnosis and therapy may minimize years of pain and disability.
Medical treatment consists of nonsteroidal anti-inflammatory medications. Indomethacin is most effective, while sulfasalazine may benefit those with more severe involvement. Peripheral joint arthritis may respond to methotrexate.
