Ankylosing Spondylitis

Ankylosing Spondylitis can vary from an intermittent episodic condition that causes back pain throughout life to a severe chronic disease that attacks the spine, peripheral joints and other body organs.

Ankylosing Spondylitis is a member of spondylarthropathies, a group of arthritic conditions with similar patterns. The cause of Ankylosing Spondylitis isn’t known but the group of spondylarthropathies share a common genetic marker, HLA-B27. In some cases Ankylosing Spondylitis will occur after the predisposed person has had a bowel or urinary tract infection, potentially triggering the autoimmune response.

Ankylosing Spondylitis affects approximately 130 out of 100,000 people in the United States. These are typically young adolescents and young adult males. There is a cultural link as it is most prevalent in Native Americans.

The first symptoms are usually a dramatic loss of flexibility in the lumbar spine. Doctors also may find arthritis present in the shoulders, hips and feet. Delay of the initial diagnosis is common because the symptoms often mimic those of other more common back problems. In other more severe cases people show up at the doctor’s office with progression to the inflammation of the eye, fever, fatigue, weight loss or anemia.

With early diagnosis and treatment people are able to decrease the amount of functional loss and pain caused by Ankylosing Spondylitis.

Two strong developments in the diagnosis and treatment of Ankylosing Spondylitis have been discovered through research. Earlier diagnosis is possible that will prevent the structural damage that results in less loss of function. Both developments are available at most hospitals.

The first is the use of Magnetic Resonance Imaging (MRI) to visualize the inflammatory changes in the sacroiliac joint. The MRI gives a much better view of the earlier changes that happen in the sacroiliac joint early in the progression of Ankylosing Spondylitis. This gives physicians a better chance to begin therapies and treatments to slow the loss of function and mobility.

The second new breakthrough is the use of tumor necrosis factor blockers. These treatments, usually reserved for patients with tumors, show a high effectiveness in reducing the spinal inflammation and slowing the progression of the disease as shown in x-ray. Unfortunately research has also shown that once the treatment has stopped most patient’s relapse. The study used this treatment over four years with little problems with toxicity for patients.

Patients and physicians have found that the simplest treatments for Ankylosing Spondylitis, such as exercise and non-steroidal anti-inflammatory drug therapies still give good relief from the degenerative response. The non-steroidal anti-inflammatory medications used are often Indomethacin and sulfasalazine. Patients with problems in their peripheral joints, arms and legs, may respond well to methotrexate.

Even with optimal therapy patients may develop a stiff back but if fusion happens in the upright position they are more functional for the remainder of their life. The goals of therapy are to increase joint flexibility and enhance lung capacity.

Ankylosing Spondylitis is a lifelong problem. Unfortunately there are those who fail to continue therapies and experience permanent posture and mobility loss. Although it can be debilitating and painful with early diagnosis and treatment patients are able to delay onset of loss of function and can continue to enjoy the activities they have always enjoyed.