What does ankylosing spondylitis mean?
Ankylosing means
fusing together.
Spondylitis indicates
inflammation of the vertebrae. Both words come from the
Greek. So, AS describes the condition by which some or all of the joints and bones of the spine
fuse together.
Entire fusing of the spine is
unusual. Many people will only have partial fusion, sometimes limited to the pelvic bones.
What exactly is AS?
AS is a
painful,
progressive,
rheumatic disease. It
mainly affects the
spine but it can also affect other joints, tendons and ligaments. Other areas, such as the
eyes,
lungs,
bowel and
heart can also be involved.
What actually happens?
Inflammation occurs at the site where certain ligaments or tendons attach to bone (
enthesis). This is followed by some erosion of bone at the site of the attachment (
enthesopathy). As the inflammation subsides, a
healing process takes place and new bone develops. Movement becomes
restricted where bone replaces the elastic tissue of ligaments or tendons. Repetition of this inflammatory process leads to
further bone formation and the individual bones which make up your backbone, the vertebrae,
can fuse together. The
pelvis is
commonly affected first. The lower back, chest wall and neck may also become involved at different times.
Is ankylosing spondylitis the same as spondylosis?
No. They
sound similar but they are
different.
Spondylosis is a term relating to "
wear and tear" and is more
common in
older people.
AS relates to an
inflammatory condition which produces new bone and leads to fusion. The vigorous exercise therapy designed for people with AS might be harmful to those suffering from spondylosis.
Who gets AS?
Men, women and children can all suffer from AS. It typically strikes people in their late
teens and
twenties, with the
average age being
24. However, symptoms can start at other periods of life.
AS is more common in men, with nearly
three times as many men having it as women.
Is AS different in men, women and children?
Yes. AS tends to affect men, women and children in slightly different ways. Men: The pelvis and spine are most commonly affected. Other joints which may be involved are the chest wall, hips, shoulders and feet.
Women: Involvement of the spine is generally less severe than in men. The pelvis, hips, knees, wrists and ankles are the most commonly involved.
Children: It is unusual for a child under the age of 11 to develop symptoms of AS. The joints which are typically affected first are the knees, ankles, feet, hips and buttocks. They rarely suffer from back pain. In youngsters, AS may lead to persistent hip disease ultimately requiring a hip replacement sometime in adult life
What are the symptoms of AS?
Typical symptoms of AS include:
•
Slow or
gradual onset of
back pain and stiffness over weeks or months, rather than hours or days.
•
Early-
morning stiffness and pain, wearing off or reducing during the day with exercise.
•
Persistence for
more than three months (as opposed to coming on in short attacks).
• Feeling
better after
exercise and feeling
worse after
rest.
•
Weight loss, especially in the early stages.
•
Fatigue.
• Feeling feverish and experiencing night sweats
Does AS affect other joints?
Yes. AS sometimes causes aching, pain and swelling in the hips, knees and ankles. Indeed, any joint can be affected. In most cases the pain and swelling will settle down after treatment. It is particularly important to stretch the hip joint to prevent stiffening in a bent position making you lean forward. The heel bone can become particularly troublesome causing pain in two areas. Most common is the under surface, about three centimetres from the back of the foot. This is called plantar fasciitis and can last for many weeks. It may respond to an insole for the shoe designed to take weight off that part of the heel. The less common pain arises at the back of the heel where the Achilles tendon is attached to the heel bone. Pressure from the shoe may aggravate the pain.
Does AS affect other organs?
Yes. AS can sometimes affect the
eyes,
heart and
lungs. These effects are
not life-
threatening and they can be treated with relative ease.
How does AS affect the eyes?
AS can cause inflammation of the iris and its attachment to the outer wall of the eye, the uvea. 40% of people will develop iritis or uveitis on one or more occasions. Usually the first symptom is a slight blurring of vision in one eye but the main symptom is a sharp pain together with a dramatically bloodshot eye. To avoid permanent damage prompt treatment should be done.
How does AS affect the heart?
Very
occasionally AS can have a mild effect on the heart. In most cases this is so mild that it is difficult to detect. AS may cause the aortic valve to leak. More commonly, though, it affects the conduction of electrical activity within the heart. Usually any such problems are unnoticed by the person with the condition.
How does AS affect the lungs?
It may affect the rib joints and the muscles between the ribs making breathing, sneezing, coughing or yawning painful. As a result, the lungs fail to become fully ventilated. Sometimes the lungs may get scarred, a condition know as apical pulmonary fibrosis. This will show up on an
X-
ray but does not usually cause any symptoms. In the late stages of AS the chest wall may become quite fixed and affect air entry in and out of the lungs. This does not mean stop breathing! The diaphragm muscle continues to work and stomach moves in and out with breathing. Large meals and tight clothing will increase the effort of breathing so it is more comfortable to avoid these. It is also vital to avoid smoking since this will not only make breathing more difficult but it could cause potentially serious lung and chest infections.
Does AS affect everybody the same way?
No. AS is a very variable disease. Some people have virtually no symptoms whereas others suffer more severely.
Will surgery needed ?
It is unlikely. Surgery plays a very small part in the management of this condition. About 6% of people with AS need to have a hip replaced. This will successfully restore mobility and eliminate pain of the damaged joint. In rare cases surgery is used to restore a straighter posture of the spine and neck to people who have become severely stooped.
Medication??
Over 80% of people with AS take non-steroidal anti-inflammatory drugs (
NSAID) to reduce inflammation and relieve pain and stiffness. However, some people may experience side-effects with NSAIDs and prefer to take simple pain killers such as
paracetamol. For others, especially those who suffer from inflammatory bowel disease (Crohn's disease and ulcerative colitis) or peripheral joint arthritis, a disease-modifying antirheumatic drug like sulphasalazine may be required.
Is AS life-threatening?
Virtually never.
What causes AS?
Not entirely sure. So far medical research has shown that 96% of people with AS in Britain all share the same genetic cell marker -
Human Leucocyte Antigen B27 (
HLA-
B27). It is possible that some normally harmless micro-organism, which on this occasion the immune system cannot fight, comes into contact with HLA-B27 and sets up an adverse reaction. Sometimes bowel infections appear to spark off AS. Symptoms may also become apparent after a period of enforced bed rest, for example following a car accident, accelerating a previously existing mild condition. A group of symptoms known as Reiter's Syndrome may also lead to AS. These include iritis (or uveitis) which is inflammation of part of the iris; and conjunctivitis which causes red, gritty and painful eyes. People with Reiter's Syndrome also suffer from urethritis. This is inflammation of the urethra, the tube that conveys urine from the bladder out of the body. This results in pain on passing urine, discharge on the end of the penis (especially on waking up in the morning) and an increased frequency of passing urine. Women may get the pain but won't notice a discharge from the urethra. Reiter's Syndrome also results in arthritis, affecting the large joints, especially in the legs, together with pain in the joints of the lower back particularly at night or on waking.
What is the risk of passing it on to children?
If a parent has AS there is a 50% chance that the B27 gene will be passed on to a child. However, not everyone with the B27 gene will go on to develop AS. Overall, the likelihood of child developing AS will be less than 1 in 10 (or 1 in 5 if B27 positive). The chance of a child inheriting the condition from a grandparent will be less than 1 in 20.
Are any other diseases associated with AS?
A skin condition called
psoriasis is associated with AS. Psoriasis causes scaly patches on the skin and scalp. It can also lead to a slightly different form of
arthritis. A sexually acquired infection known as
Non-
Specific Urethritis (NSU) can be caused by an organism called
chlamydia. This leads to urethritis and sometimes other features of
Reiter's Syndrome.
Ulcerative colitis or
Crohn's disease are also related to AS but are not caused by it. The symptoms are bouts of bloody diarrhoea, often with fever, weight loss, and an associated peripheral arthritis in some cases.
Is there a cure for AS?
Alas,
there is not! Anti-inflammatory drugs will help to reduce pain and improve sleep and general well-being. But drugs are only half the answer.
Appropriate exercise is crucial to managing your AS. The drugs should enable you to carry out these exercises with less pain.
What is the end result?
AS seems to affect everybody slightly differently. In general, though,the symptoms come and go over many years. In the classic case, the lumbar spine can become stiff, caused by the growth of additional bone, as can the upper spine and neck. If attention is paid to posture, exercising regularly and avoiding the stoop associated with the condition,this from becoming too serious can be prevented.
source:
NASS.UK
Re: Ankylosing spondylosis -
06-02-2007, 02:46 AM
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