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Ankylosing Spondylitis

Ankylosing Spondylitis is a chronic, painful, progressive inflammatory arthritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine. It is a member of the group of the autoimmune spondyloarthropathies with a probable genetic disposition, that is, a tendency for some people to be affected more so than others. Complete fusion results in total rigidity of the spine, a condition known as bamboo spine.

Signs and Symptoms

The typical patient is a young man, sometimes a woman, 15-30 years old with chronic pain and stiffness in the lower part of the spine. In 40% of cases, Ankylosing Spondylitis is associated with indocyclitis causing eye pain and photophobia (increased sensitivity to light). Other common symptoms are recurring mouth ulcers (aphthae), and fatigue. Typical early symptoms may occur in toddlers. The patient may experience recurring knee pain, commonly misinterpreted as simple rheumatism.

Etiology

The result of Ankylosing Spondylitis is an abnormal union of the bones of a joint in the spine with resulting inflammation, articular cartilage destruction and a bony union due to bone surfaces coming into direct contact.

Diagnosis

There is no direct test to diagnose Ankylosing Spondylitis. A clinical examination and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis, are the major diagnostic tools. A drawback of X-ray diagnosis is that signs and symptoms of Ankylosing Spondylitis have usually occurred as long as 8-10 years prior to X-rays, delaying the introduction of adequate therapies. A more accurate and quicker diagnosis is available with tomography and magnetic resonance imaging of the sacroiliac joints.

During acute inflammatory periods, patients will usually show an increase in the blood concentration of C-reactive protein (CRP) and an increase in the erythrocyte sedimentation rate (ESR). If left untreated, Ankylosing Spondylitis normally leads to knee pain and may be accompanied by Dactylitis (an inflammation of a finger or toe) or Enthesitis (inflammation and often fibrosis and calcification where bone and muscle connect). Often it is misdiagnosed as rheumatism. If undiagnosed and untreated for an extended time, Osteopenia or Osteoporosis of the spine may occur, causing eventual compression fractures and a back "hump."

Medical Treatment for Ankylosing Spondylitis

No cure is known for Ankylosing Spondylitis. Physical therapy and exercise, along with medication, can reduce pain and inflammation, though they should be monitored by a physician. Exercising in an active inflammatory state will make the pain worse. (Below are home treatment products offered by Pain Relievers that are designed to provide assistance and relief)

Three Major Types of Medications.

• NSAIDS such as aspirin, ibuprofen, indomethacin, naproxen and COX-2 inhibitors reduce inflammation and pain. Commonly used anti-inflammatory drugs such as nimesulide are less effective.
  
  
• DMARDS such as cyclosporine, methotrexate, sulfasalazine, and corticosteroids are used to reduce the immune system response through immunosuppression.
  
  
• TNF a blockers (antagonists) such as etanercept, infliximab and adalimumab (also known as biologics), are effective immunosuppressants. TNFa blockers have been shown to be the most promising treatment, slowing the progress of Ankylosing Spondylitis in the majority of clinical cases. They have also been shown to be highly effective in treating not only the arthritis of the joints but the spinal arthritis associated with Ankylosing Spondylitis.These drugs, however, increase the risk of infections.
  
  For this reason, a test for Tuberculosis (such as Mantoux or Heaf) is needed before starting treatment. In case of recurrent infections, such as a recurrent sore throat, the therapy may be suspended because of the immunosuppression. In some cases of Ankylosing Spondylitis, joint replacement, particularly in the knees and hip, is a surgical option. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature of the spine, particularly in the neck), although this procedure is considered risky.

Home Treatment

• Physical therapy, including cold packs and hot packs, has been shown to be of great benefit to Ankylosing Spondylitis patients.
• Swimming is one of the preferred exercises because it involves all muscles and joints in a low gravity environment.
• Slow movement exercises such as stretching, yoga or tai chi are beneficial. There are yoga videos available.
• Any time there is inflammation in the spine, back ice packs and neck ice packs can help relieve the pain and inflammation associated with Ankylosing Spondylitis.
• A lower back brace  provides compression and support as well as pain relief for those with back pain. Care must be taken to wear braces intermittently to avoid loss of strength in the back.
• A soothing massage can help relieve back pain from over tight and spastic muscles.
• Magnetic Therapy has been used by millions of people for centuries. It is believed that magnets provide the body the missing electrical current it needs to function properly and that by restoring this nerve energy, the body's electrical system can be reset. Note: There are no medical studies that prove magnetic therapy is efficacious in this manner. Use only with a doctor's advice.
• Mobility aids such as walkers and canes can be very valuable accessories because Ankylosing Spondylitis can lead to immobility.
• Back support while sitting can provide a world of relief when suffering from Ankylosing Spondylitis. Lumbar pillows can be used while sitting in your favorite chair or driving your car.
•  Massage chairs and recliners offer great support, massage and heat and are the ultimate in relaxation.