Ankylosing spondylitis

Ankylosing spondylitis

Definition:

Spondylitis involves inflammation of one or more vertebrae. Ankylosing spondylitis is a chronic inflammatory disease that affects the joints between the vertebrae of the spine, and the joints between the spine and the pelvis. It eventually causes the affected vertebrae to fuse or grow together. (See arthritis).

Alternative Names:

Rheumatoid spondylitis; Spondylitis, spondylarthropathy

Causes, incidence, and risk factors:

The specific cause for this disease is unknown, but genetic factors seem to play a role. The disease starts with intermittent hip and/or lower back pain that is worse at night or after inactivity. Back pain begins in the sacroiliac joint (joint between the pelvis and the spine) and may progress to include the lumbosacral spine and the thoracic spine (chest portion of the spine). Pain may be eased by assuming a bent posture. Limited expansion of the chest occurs because of the involvement of the joints between the ribs. The symptoms may worsen, go into remission, or stop at any stage.

With progressive disease, deterioration of bone and cartilage can lead to fusion in the spine or peripheral joints affecting mobility. It can be extremely painful and crippling. The heart, the lungs, and the eyes may also become affected. The disease most frequently begins between the ages of 20 and 40 but may begin before 10 years of age. It affects more males than females. Risk factors include a family history of ankylosing spondylitis and male gender. About 0.21% of Americans over age 15 are affected.

Symptoms:

low back pain that is worse at night or after inactivity
stiffness and limited motion in the low back
hip pain and stiffness
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
neck pain
heel pain
chronic stooping to relieve symptoms
fatigue
fever, low grade
loss of appetite
weight loss
eye inflammation

Signs and tests:

Physical examination and characteristic symptoms are indicative of limited spine motion or chest expansion.

Tests may include:

HLA-B27 antigen test is positive.
A spine X-ray or pelvis X-ray shows characteristic findings.
ESR may or may not be elevated.
CBC may show mild anemia.

Treatment:

The objective of treatment is to relieve the joint pain and to prevent, delay, or correct
deformities.

Medications:
Nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin are used to reduce inflammation and pain associated with the condition. These medications enable the use of exercise programs that include exercises to improve posture and breathing. (Note: DO NOT give aspirin or other NSAIDs to children unless advised to do so by the health care provider!)

Corticosteroid therapy or medications to suppress the immune system may be prescribed to control the various manifestations of severe disease. Some health care professionals use cytotoxic drugs (drugs that block cell growth) in people who do not have a good response to corticosteroids or who are dependent on high doses of corticosteroids.

Surgery:
Surgery is done if pain or joint damage is severe.

Lifestyle changes:
Exercises to improve posture and breathing. Use of devices to help with activities of daily living.

Expectations (prognosis):

The course of the disease is unpredictable; remissions and relapses may occur at any stage. Most people are able to function unless the hips are severely involved.

Complications:

heart valve disease, typically aortic valve stenosis
aortitis
eye inflammation (uveitis) (iridocyclitis)
pulmonary fibrosis

Calling your health care provider:

Call your health care provider if you have symptoms of ankylosing spondylitis or if you have ankylosing spondylitis and new symptoms develop during treatment.

Prevention:

Prevention is unknown. Awareness of risk factors may allow early detection and treatment.

Review Date: 11/27/2001
Reviewed By: Birgit Kovacs, M.D., Division of Rheumatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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