| Ankylosing Spondylitis is a type of arthritis causing
inflammation of the spine. It is most common in teens and young
adults although it can also affect children and older people. Ankylosing
spondylitis affects about 1 out of every 200 adults. The
inflammation mainly affects the joints of the spine and
the joints between the spine and pelvis (sacroiliac joints).
However, inflammation may also affect other areas of the body.
Though ankylosing spondylitis is a chronic condition, there
may be periods of remission. The severity and the progression
of the disease varies from person to person.
Though the exact cause of ankylosing spondylitis remains unknown,
genes that increase the chances of a person developing the
disease have been identified. Because there is more that one
gene involved, the chances of a person passing this disease
to his or her children are fairly low.
Ankylosing Spondylitis Diagnosis
Diagnosis ankylosing spondylitis is often difficult in the early
stages or mild cases as back pain is very common and usually caused
by muscle strain. An x-ray of the spine and sacroiliac
joints is taken. Degenerative changes are usually
first seen in the sacroiliac joints. A rheumatologist
that specializes in ankylosing spondylitis can usually make an accurate
diagnosis.
Ankylosing Spondylitis Symptoms
The symptoms and severity of ankylosing spondylitis vary - from
mild to severe back pain, from mild stiffness to loss
of mobility. Symptoms may come
and go. In the early stages, inflammation of the sacroiliac
joints causes hip pain (deep within the buttocks) and lower back
and stiffness, especially at night, in the morning, and after
periods of inactivity.
Later,
the inflammation may spread further up the spine and to other
joints. If inflammation occurs in the joints between
the ribs and spine, pain may be felt in the chest area. The hips,
shoulders, heels or knees are sometimes affected. Sometimes
there is inflammation of the eyes. Very rarely,
the inflammation may involve the heart.
There may
be fatigue, lack of appetite, weight loss, a low-grade fever. In
severe cases, the spine sometimes fuses in a stooped over position.
This can be avoided.
Preventing Stooping
Inflammation damages the joints. Scarring of the tissues and
extra bone overgrowth can develop as a result of chronic inflammation.
Eventually, in some severe cases of ankylosing spondylitis, the
ligaments of the spine become fused together by bony overgrowth
of the vertebrae – this
is called ankylosis.
Not all cases of Ankylosing spondylitis reach this stage, but
maintaining good posture is essential so that if the spine does
fuse the spine will be in a fixed upright position rather
than a fixed hunched over position. Click
here for information on proper posture.
Strengthening exercises for the
muscles that support the spine and stretching
exercises help
maintain proper posture. A physical therapist can create
a customized exercise program for a patient to follow. Exercise
plays a vital role in managing this disease.
Medications Used to Treat Ankylosing Spondylitis
Medications for Ankylosing spondylitis are geared at reducing inflammation.
NSAIDs:
Ankylosing Spondylitis is with NSAIDs -nonsteroidal
anti-inflammatory drugs. NSAIDs treat the pain and inflammation.
Ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, ) and indomethacin
(Indocin) are NSAIDs.
When NSAIDs are not effective enough other medications are often
used.
Sulfasalazine, often used for inflammatory bowel
disease, also can reduce pain and inflammation in the joints and
is sometimes used to treat ankylosing spondylitis.
Immunosuppressive agents:
Drugs that suppress the immune system, such as Azathiprine, or
Methotrexate are sometimes used to treat Ankylosing spondylitis.
Immunosuppressive agents are used to suppress the inflammatory response
by suppressing the immune system.
The immune system seems to be overly sensitive in people with
Ankylosing spondylitis and certain cells of the immune system that
initiate inflammation may be triggered too easily.
Corticosteroids (such as prednisone) have extremely
powerful anti-inflammatory properties and also suppress the immune
system. The problem with corticosteroids is that the side effects
are severe in long-term use and the person taking them can develop
a host of other unwanted problems.
TNF Inhibitors:
One class of drugs,TNF Inhibitors (such as Remicade), has shown
a lot of promise in treating ankylosing spondylitis along with other
chronic inflammatory diseases. Remicade suppresses inflammation
by binding to and neutralizing substances (TNFa) that act as an
alarm signal that triggers inflammation. New drugs in this class
are being developed.
Immunosuppressive agents, corticosteroids, and Remicade
all increase the risk of infection.
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