Ankylosing Spondylitis

Ankylosing Spondylitis is a disorder which is mainly characterized by lower back pain that spreads to the hips, knees, and heels that can lead to progressive natural fusions of the vertebral bodies and forward angulation of the neck. Most of the affected individuals have the HLA-B27 gene. The disease course is highly variable, and while some individuals have episodes of transient back pain only, others have more chronic severe back pain that leads to differing degrees of spinal stiffness over time. One in 2000 people in the UK have AS. It is more common and often more severe in men than in women, and usually begins between the ages of 16 and 40 years. Rarely, ankylosing spondylitis can also have serious complications involving the heart and lungs.

Ankylosing spondylitis (AS) is genetically, clinically, epidemiologically, and radiographically related to a family of diseases historically know as the seronegative spondyloarthropathies. Other members of this disease group include (a) juvenile spondylitis; (b) reactive arthritis (ReA); (c) psoriatic arthritis associated with spondylitis; (d) the arthropathies associated with inflammatory bowel disease (ulcerative colitis, and Crohn's disease); and (e) undifferentiated spondylitis in which features of two or more of these disorders occur in the same patient but do not fulfill criteria for any of the above mentioned groups.

Ankylosing Spondylitis is a auto-immune condition which can be defined as the inflammatory arthritis which mainly affects the spinal joints primarily in males and the condition causes back pain and stiffness, and can lead to deformities of the spine and damage to the spinal cord. As the disease progresses, the affected bones fuse together, resulting in a stiff ("bamboo") spine. It is an inflammatory arthritic disorder that affects males more often than females. It eventually causes the affected vertebrae to fuse or grow together. It is inflammatory disease of unknown origin That causes the sacro-iliac joints and spinal vertebrae to fuse. In severe cases, inflammation of the vertebrae can eventually cause them to fuse together leading to severely limited mobility. Ankylosing spondylitis affects the eyes in up to 40 percent of cases, leading to episodes of eye inflammation called acute iritis. After the inflammation has subsided, new bone is created as part of the healing process.

Diagnosis of Ankylosing Spondylitis

Several classification criteria exist for the ( Ankylosing Spondylitis) spondyloarthropathies; however, definitive diagnosis is often delayed because of the reliance on radiographic criteria for sacroiliitis, and ongoing efforts are underway to develop diagnostic criteria that will help identify patients at earlier stages of disease Ankylosing Spondylitis.

Although symptoms of inflammatory back disease, especially in young men, and the typical spinal abnormalities on physical examination, when present, should strongly suggest the diagnosis of Ankylosing Spondylitis, the most specific diagnostic findings are the characteristic radiographic changes. Sacroiliitis, especially when bilateral, is a virtual prerequisite for definite diagnosis.

Sign and Symptom of Ankylosing Spondylitis

Males appear to be affected two to three times more frequently by (Ankylosing Spondylitis) AS than female subjects; however, females often have atypical presentations and are underdiagnosed. The prevalence of Ankylosing Spondylitis has been best studied in white populations and varies from 0.2% in white Americans to 0.9% in white Germans to 1.4% in northern Norwegian populations.

Epidemiologic studies in humans showed that outbreaks of infections with microorganisms such as Salmonella and Campylobacter were followed by joint symptoms and enthesitis in genetically susceptible individuals. Less commonly, patients with Ankylosing Spondylitis may have a peripheral arthritis, typically monoarticular or oligoarticular, and often affecting one or both knees. Some common symtoms following are :-

• limited expansion of the chest
• limited range of motion , especially involving spine and hips
• joint pain and joint swelling in the shoulders, knees, and ankles
• Stiff, inflexible spine
• Fatigue
• Loss of appetite
• Weight loss
• Eye inflammation (iritis)
• Bowel inflammation
• general feeling of being unwell
• occasional inflammation of the eye (iritis)

Cause of Ankylosing Spondylitis

The cause of inflammation in Ankylosing Spondylitis is unknown; however, the fact that environmental factors are involved in the pathogenesis of AS has been firmly established by the fact that concordance is not complete between identical twins. Pathogenic hypotheses for Ankylosing Spondylitis have only recently been confirmed by experimental data.

Ankylosing Spondylitis sometimes exists at birth. In this case swelling is seen when the infant is an upright position and disappears when the infant is laid upon its back. Ankylosing Spondylitis usually disappears by itself in infants.

Treatment of Ankylosing Spondylitis

The major aims of Treatment of Ankylosing Spondylitis include (a) the pharmacologic relief of pain and stiffness; (b) a physical therapy and lifestyle modifications program aimed at preserving spinal mobility or, at least, preventing spinal deformity and disability; and (c) the prompt recognition and management of articular and extraarticular complications. It is essential that the patient be well educated in the natural history of this disease and the rationale for each treatment modality.

• The goal is to relieve the joint pain and to prevent, delay, or correct deformities. the main consists of a long-term programme of physical activity and, when necessary, anti-inflammatory drugs. A specialist physiotherapist can provide more advice. Daily exercises such as spine extension and breathing are often recommended to strengthen muscles and prevent poor posture.
• Nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin are used to reduce inflammation and pain associated with the condition. They allow patients to exercise, which improves posture and breathing.
• Corticosteroids are occasionally injected into particularly painful joints and used as drops for eye inflammation.
• Treatment of ankylosing spondylitis is most successful early, before it causes irreversible damage to your joints, such as fusion, especially in positions that limit your function

Conclusion: Ankylosing Spondylitis is a chronic inflammatory process that is insidious in onset and may progressively lead to spinal fusion. The pathogenesis of Ankylosing Spondylitis is becoming better understood, and immune-mediated mechanisms involving HLA-B27, cytokines, inflammatory cellular infiltrates, and genetic and environmental factors are thought to have key roles.

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