Ankylosing spondylitis - also called rheumatoid spondylitis or Marie-Strümpell disease - primarily affects the sacroiliac, apophyseal, and costocervical joints and the adjacent ligamentous or tendinous attachments to bone.
This inflammatory disease progressively restricts spinal movement. It begins in the sacroiliac and gradually progresses to the lumbar, thoracic, and cervical spine. Bone and cartilage deterioration leads to fibrous tissue formation and eventual fusion of the spine or peripheral joints. Symptoms can unpredictably remit, exacerbate, or arrest at any stage. An autoimmune correlation is possible.
Ankylosing spondylitis usually occurs as a primary disorder, but it may also occur secondary to reactive arthritis (Reiter's syndrome), psoriatic arthritis, or inflammatory bowel disease. These disorders, together with primary ankylosing spondylitis, are classified as seronegative spondyloarthropathies.
In primary disease, sacroiliitis is usually bilateral and symmetrical; in secondary disease, it's commonly unilateral and asymmetrical. The patient may also have extra-articular disease, such as acute anterior iritis (in about 25% of patients), proximal root aortitis and heart block, and apical pulmonary fibrosis. Rarely, extra-articular disease appears as caudal adhesive leptomeningitis and immunoglobulin (lg) A nephropathy.
Ankylosing spondylitis affects men more often than women. Progressive disease is well recognized in men but often overlooked or missed in women, who have more peripheral joint involvement.
The cause of AS is not known, but all of the spondylarthropathies share a common genetic marker, called HLA-B27, in most affected individuals. In some cases, the disease occurs in these predisposed people after exposure to bowel or urinary tract infections.
Your condition may change over time, with symptoms getting worse, improving or completely stopping at any point. Early signs and symptoms may include pain and stiffness in your lower back and hips - which is often worse in the morning, at night and after periods of inactivity. Over time, the pain and stiffness may progress up your spine and to other joints, such as those in your hips, shoulders, knees and feet.
In advanced stages, the following signs and symptoms may develop:
If your pattern of symptoms fits the description of AS, your doctor will order x-rays of the spine and pelvis. He or she will look for wear at the joint between the spine and the hip bone, and for abnormalities in the vertebrae. A simple blood test may also reveal the HLA-B27 gene. If AS is diagnosed, you will be referred to a rheumatologist, which is a doctor who specializes in treating arthritis.
Because no treatment reliably stops disease progression, management is used to delay further deformity by stressing the importance of good posture, stretching and deep-breathing exercises and, if appropriate, braces and lightweight supports. Heat, warm showers, baths, ice, and nerve stimulation measures may relieve symptoms in some patients. Nonsteroidal anti-inflammatory drugs, such as aspirin, indomethacin, and sulindac, control pain and inflammation. Phenylbutazone may be used in severe cases.
Severe hip involvement, which affects about 15% of patients, usually necessitates hip replacement surgery. Severe spinal involvement may require a spinal wedge osteotomy to separate and reposition the vertebrae. This surgery is reserved for selected patients because of possible spinal cord damage and a lengthy convalescence.
Prevention is unknown. Awareness of risk factors may allow early detection and treatment.
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