Lower back pain
that may be intermittent or persistent. Pain may be worse at
stiffness in the back or hips that improves with activity.
chest capacity due to pain and stiffness in the ribs.
or chest pain.
pain, blurred vision, watery eyes, and aversion to light (due
in the peripheral joints.
When To Call Your Doctor
an appointment with a doctor for any persistent back pain.
What Is It?
Ankylosing spondylitis (AS) is an uncommon type
of inflammatory arthritis that primarily affects the joints of
the spinal column. Typically, AS originates in the sacroiliac
joints, where the vertebrae of the spine meet the pelvis. The
disease tends to progress from the lower back up to the vertebrae
in the neck. (Peripheral joints are also involved in as many
as 25 percent of cases, especially among women.) Cartilage and
other tissue between the joints gradually deteriorate and are
replaced by hard, fibrous tissue. Eventually the bones fuse together
and joint flexibility is lost. Symptomsprimarily lower
back pain and stiffnessoften first appear in late adolescence
or early adulthood; onset after age 45 is very rare. Early onset
of the disease is associated with a worse prognosis.
The most serious complication is spinal fracture
that can result in quadriplegia; however, most patients suffer
no serious disability despite the pain and are able to continue
working. The disease may get progressively worse, stabilize,
or go into remission at any point. About 25 to 30 percent of
AS patients are affected by inflammation and scarring of structures
within the eye, and a few patients may develop an abnormality
of the aortic valve in the heart or scarring of lung tissue.
Ankylosing spondylitis is more common among whites than other
races and is three times more prevalent in men than women.
What Causes It?
o The cause of AS is unknown, though hereditary
factors appear to play a role. There is also evidence suggesting
a link between intestinal bacteria or inflammation and the autoimmune
activity (in which the body's defenses against disease attack
healthy tissue) involved in the mechanism of joint deterioration.
There is no
known way to prevent AS.
laboratory tests exist to distinguish AS from similar inflammatory
diseases. Diagnosis is primarily based on patient history, physical
examination, and x-ray findings.
may detect a specific antigen (HLA-B27) that is present in 90
percent of patients with AS. The presence of this antigen does
not confirm the diagnosis (it is also seen in 6 to 8 percent
of normal whites), but does suggest a genetic predisposition
to the disease.
reveal signs of joint deterioration in the spine, pelvis, or
How To Treat It
There is no
specific way to treat AS; therapy is aimed at relieving discomfort
and maintaining joint function.
anti-inflammatory drugs (NSAIDs), especially indomethacin, are
commonly prescribed to ease pain and inflammation.
exercises and other forms of physical therapy may help to maintain
or improve flexibility.
supports are not helpful and are not advised.
direct injections of corticosteroids may be beneficial in patients
unresponsive to NSAIDs.
in the hips may warrant total hip replacement surgery (arthroplasty).
occurs, it can be treated with corticosteroids and medicated
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