Posts Tagged ‘ankylosing spondylitis’
A person with cervical spondylosis has destruction of the joints and disks located between the bones in the neck. The swelling and collapse of the disk can place pressure on the nerves that pass between the bones of the neck. This can result in malfunction of the nerves that control the arms. Cervical spondylosis is a disorder caused by abnormal wear on the cartilage and bones of the neck (cervical vertebrae). The tissue wears away (degeneration) and mineral deposits form in the cushions between the vertebrae.
The most common presenting symptom is low back pain. Usually, pain is centered over the sacrum and may radiate to the groin and buttocks and down the legs. The typical patient is a young man who has repeated episodes of back pain waking him at night and associated with spinal stiffness in the morning. Low back pain persists, even at rest. With time, back pain progresses up the spine and affects the rib cage.
Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty.
Causes of cervical spondylitis and depression According to Ayurvedic principles of curative, the aridness and inelasticity can be checkered by use ghrit- medicated butteroil or cow’s ghee in restraint. The deterioration can cause several of the discs to bulge out and can reason the central cartilage of the discs to protrude through a break in the ring that environs the disc (herniate). The nearby ligaments turn out to be less flexible, and the vertebrae might expand bone spurs.
Symptoms: Pain in the neck. This may spread to the base of the skull and shoulders. Movement of the neck may make the pain worse. The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck. The pain tends to wax and wane with flare-ups from time to time. However, some people develop chronic (persistent) pain.
Initial treatment of cervical spondylosis may include measures taken to allow the area time to heal. A doctor may suggest that the person wear a neck brace to take pressure off the vertebrae and allow the pain to subside. For more severe cases it may be necessary to put the person in traction in a hospital to take all the pressure off the vertebrae and give them a chance to heal.
In the event that these therapeutic approaches do not work a doctor may decide to use surgery. Surgery may be done to eliminate bone spurs that are putting pressure on nerves or it may be done to fuse vertebrae together and stop the pressure on the surrounding nerves.
Arthritis is probably the one most common seen inflammation on the bodily joints that normally result in much pain. Typical of this joint pain is swelling, stiffness, and rigid movement. In the medical fields, there are many different types of arthritis.
The sheer pain arising from arthritis on any parts or joints of the body is enough to prevent and limit daily normal working activities. On a more serious case, it can cause total disability that will result in the total inability to undertake any normal duty. It should be noted that while this is common problem, many sufferers do not really know how best to treat it. It is necessary to understand the cause of it, and the need to address this joint pain in two parts; one to be aware of the treatments available and secondly to steer clear of daily chores or activities that may worsen the affected area.
Arthritis is a result of the wear and tear of joints or cartilage. A direct cause is aging. As the person gets older, the cartilage that protects the joint wears off. This cartilage protects the joint and without the cushion, the bones rub into each other resulting in pain, inflammation or swelling and tautness.
The other common causes are a result of the over exertion or usage putting overwhelming pressure on the joints. This is obvious that many athletics fall victims to this arthritis through their quest for excellence sporting achievement. Many may call this sport injury. Other normal activities may also contribute to this joint pain such as the routine carrying of heavy loads relative to one’s weight. Occupational hazard as we called it. It may be true that an obese person may have a higher rate of contracting arthritis relative to their peers who maintain a healthy body shape due to the upper bodily weight acting as constant pressure on the lower joints.
Joint inflammation can happen due to various reasons. The common problems include;
Fractured bone due to accident or injury
Breakdown of the cartilage due to old age or injury. Osteoarthritis is common in old age
Infection caused by bacteria or viruses
Prior injury. Sport injury
Normal course of anti-inflammatory drugs may get the swelling to go off once the injury, disease or infection is healed.
Certain inflammation may not go away after medications. And if this joint pain resurfaces regularly the possibility of contracting arthritis is imminent. Swelling is most common to occur in areas around the fingers, hips or knees.
Other common causes of arthritis include:
Adult Still’s disease
Reactive arthritis or also known as Reiter syndrome
Rheumatoid arthritis (in adults)
Juvenile rheumatoid arthritis (in children)
A Pain deep in the cheeks of your bottom can be referred from the lower back. There does not necessarily have to be pain in the lower back as well for pain to be referred into the buttocks.
What are the symptoms of pain referred from the back?
An aching in the buttocks that is difficult to pinpoint.
The slump test may reproduce buttock pain which is eased when the neck is relaxed back (extended).
Areas of the lumbar spine may be tender and have poor mobility.
Tight gluteal muscles and other muscles of the buttocks.
What can I do?
See a Physical Therapist who can identify the problems in the lower spine.
Begin an exercise programme that will stretch and strengthen the muscles supporting the lumbar spine.
Stretch the gluteal muscles and hip rotator muscles.
What can a Physical Therapist professional do?
Manipulate and mobilize the segments of the lumbar spine. This is a good way of assessing whether the lumbar spine is a cause of buttock pain. If it is then symptoms will be relieved.
Deep tissue sports massage techniques can be applied to the lower back and buttocks to release muscle tension, particularly in chronic conditions.
Acupuncture or dry needling can also help reduce chronic tension in muscles.
What other injuries are related or similar?
Sacroiliac joint pain.
What is the Sacroiliac joint ?
The Sacroiliac Joints are located at the bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum and the ilia.
There are torsional or twisting forces applied to the pelvic girdle when the lower limbs are moved. These limbs act like long levers and without the sacroiliac joints and the pubic symphysis (at the front of the pelvis) which allow movement, the pelvis would very likely be subject to a fracture.
These joints can often get stuck or in some cases one half of the pelvis can glide forwards or backwards, which is often referred to as a twisted pelvis. When this occurs it often irritates the Iliolumbar ligament which results in Inflammation. This is usually indicated by tenderness around the bony lumps which you can feel if you place your thumbs either side of your lower back.
Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and this results in the relaxation of ligaments in preparation for childbirth. In most cases the causes of sacroiliitis are mechanical, however there may be other medical inflammatory conditions present such as Ankylosing Spondylitis as well as others which will need attention.
Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.
The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.
Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.
Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.
Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.
Aching to one side of your lower back when driving long distances.
Specific assessment tests:
The Stork test – to assess weather the sacroiliac joint is moving correctly.
Leg length difference measurements – both straight leg and bent leg assessments.
Ilia rotation – this assesses weather the ilia is rotated on one side creating imbalance.
What can a Physical Therapist or GP do?
Use diagnostic tests to discover the cause of the problem.
Eliminate medical diseases such as Ankylosing Spondylitis..
Treat the cause as well as the symptoms.
Prescribe anti-inflammatory medication (e.g. ibuprofen) and rest.
Use electrotherapy equipment to treat affected tissues.
If indicated and safe to do, level the pelvis via manipulation.
Articulate sacroiliac joint and restore normal function.
Sports massage will help relieve any soft tissue tension in the area.
Use injection therapy.
Advise Ice and cold therapy to reduce inflammation.
What are the similar or related injuries and conditions?
Low back pain
What does French tennis player Tatiana Golovin, comedian Lee Hurst or Taiwanese musician Jay Chou have in common? It’s none other than the disease known as ankylosing spondylitis.
Formerly known as Bechterew’s disease, Bechterew syndrome and Marie Strumpell disease, ankylosing spondylitis is a chronic, inflammatory arthritis and auto immune disease, which mainly affects the joints in the spine, the sacroilium in the pelvis and in the long run, can cause the merging of the spine. This disease typically affects young male, aged 18 to 30. Symptoms such as chronic pain and stiffness in the lower part or the entire spine, which indirectly inflicts pain in the buttocks or the back of thighs are often most apparent. In some cases, this disease can cause inflammation of the eye which leads to eye pain, floaters, redness, and photophobia and vision loss. This disease can sometimes cause fatigue and nausea. If one is to contract the disease before 18, symptoms such as the swelling and pain of large limb joints, particularly the knees will occur, followed by the ankles, feet and the spine.
Although treatments and medications are available to reduce pain and symptoms, there is no known cure for ankylosing spondylitis. Treatments such as physical exercises and physiotherapy, along with medication, are often used by physicians to help reduce the inflammation and pain. The most recommended physical exercises by rheumatologists include swimming, stretching, yoga, tai chi, climbing and Pilates whereas jogging is the least recommended. The three major types of medications include anti-inflammatory drugs such as NSAIDS and COX-2 inhibitors, DMARDS and TNF? blockers (antagonists). In some cases, walking aids are used to assist in balancing and relieving the pressure on affected joints. Most patients of ankylosing spondylitis are normally advised to alternate their time between resting, sitting and standing due to the difficulties that they experienced. Apart from that, it is important for them to maintain a good posture to reduce the chances of causing a curved or fused spine.
Lastly, surgery will only be an option in the form of joint replacements, particularly the hips and knees, in severe cases.
Natural Cure For Cervical Spondylitis And Depression And Remedies For Cervical Spondylitis And Depression
Cervical Spondylitis is also recognized as cervical osteoarthritis or cervical Spondylitis. It usually affects the men and women older than 40 and progress with age. People with less bone thickness or low calcium diet are prone to this state. Cervical Spondylitis is agening connected degenerative osteoarthritis of the neck spine. Cervical Spondylitis is a chronic deterioration of the neck bones but too the cushions or the bury vertebral discs are also concerned. Causes of cervical spondylitis and depression According to Ayurvedic principles of curative, the aridness and inelasticity can be checkered by use ghrit- medicated butteroil or cow’s ghee in restraint. The deterioration can cause several of the discs to bulge out and can reason the central cartilage of the discs to protrude through a break in the ring that environs the disc (herniate). The nearby ligaments turn out to be less flexible, and the vertebrae might expand bone spurs. Intermittent, reasonable to severe neck ache and stiffness with a harshly restricted variety of motion (ROM) is trait of ankylosing spondylitis. Irregular low back pain and rigidity and arm pain are generally inferior in the morning or after periods of idleness and are usually reassured after exercise. Symptoms of cervical spondylitis and depression a. Neck ache that radiate to the shoulder and arms b. Numbness or tingling feeling or flaw in the arms, hands and fingers c. Headaches that give out to the rear of the head d. Loss of equilibrium, dizziness e. Numbness or flaw in the legs, if lumbar spine are involved and if the spinal cord is dense f. Loss of bladder or bowel manage, if the lumbar vertebrae are concerned and if the spinal cord is dense What not to eat to get Relief from cervical spondylitis and depression a. Stay way from all type of our food substance reminiscent of curd; b. Such patients ought to not also contain pulses (in any form) and fried food. c. Refined food preparation items reminiscent of oil ghee or additional solid and liquid finished food crop must not be in use at all. Treatment to get Relief from cervical spondylitis and depression a. A high-quality posture may help. Make sure that your sitting place at work or at the computer is not deprived. Sit position. Yoga, Pilates, and the Alexander method all get better neck posture, but their worth in treat neck pain is unsure. b. A firm supporting pillow seems to assist some people when latent. Try not to use additional than one cushion. c. Paracetamol at full power is often enough. For an mature this is two 500 mg tablets, four times a day. d. A stronger anesthetic such as codeine is an alternative if anti-inflammatories do not outfit or do not employment healthy. Codeine is often full in adding up to paracetamol. Constipation is a ordinary consequence from codeine. Home Remedies to get Relief from cervical spondylitis and depression a. Patients have to contain 4 meals a day consisting of milk, salad of raw vegetables, steamed vegetables, whole-wheat cash and sprouts. Natural home medicine for cervical Spondylitis. b. Adequate amount of proteins, vitamin C, Vitamin D, calcium and phosphorus are too necessary. c. One should also keep away from sour curd, sugar, spicy, fried and fatty foods, tea and coffee, refined and process food and tobacco and smoking. d. People with sedentary job should change position often, stand up each hour, keep away from soft cushion seats, use thin pillow or avoid it, and sleep on solid mattresses with knees twisted at correct angles to the torso.
I video I put together for a project at school about Ankylosing Spondylitis
Video Rating: 4 / 5
Celecoxib is one of the medicines used in rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute pain, painful menstruation and menstrual symptoms, and to reduce the number of colon and rectal polyps in patients with familial adenomatous polyposis. It is in a class of NSAIDs called COX-2 inhibitors. It exhibits anti-inflammatory, analgesic, and antipyretic action due to inhibition of COX-2 enzyme. It works by stopping the body’s production of a substance that causes pain and inflammation.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and deformity of the joints. Other problems throughout the body (systemic problems) may also develop, including inflammation of blood vessels (vasculitis), the development of bumps (called rheumatoid nodules) in various parts of the body, lung disease, blood disorders, and weakening of the bones (osteoporosis). RA exists all over the world and affects men and women of all races wherein women being affected 3 times more than men. About 80% of people with RA are diagnosed between the ages of 35 to 50. RA appears to run in families, although certain factors in the environment may also influence the development of the disease. The underlying event that promotes RA in a person is unknown. RA can begin very gradually, or it can strike quickly. The first symptoms are pain, swelling, and stiffness in the joints. The most commonly involved joints include hands, feet, wrists, elbows, and ankles, although other joints may also be involved. The joints are affected in a symmetrical fashion. This means that if the right wrist is involved, the left wrist is also involved. The joints may be difficult to straighten, and affected fingers and toes may be permanently bent (flexed). The hands and feet may curve outward in an abnormal way. There is no known way to prevent the development of RA, but many different types of treatment can alleviate symptoms and modify the disease process.
Ankylosing spondylitis also called as rheumatoid spondylitis or Marie-Strümpell disease refers to inflammation of the joints in the spine. AS is characterized by chronic inflammation, that causes pain and stiffness of the back, progressing to the chest and neck. Eventually, the whole back may become curved and inflexible if the bones fuse (this is known as “bamboo spine”). AS is a systemic disorder that may involve multiple organs, such as the eye (causing an inflammation of the iris, or iritis), heart (causing aortic valve disease), lungs, skin (causing a scaly skin condition, or psoriasis), and the gastrointestinal tract (causing inflammation within the small intestine, called ileitis, or inflammation of the large intestine, called colitis). The cause of AS is still unknown. Genetics play an important role in this disease. Symptoms of AS include low back and hip pain and stiffness, difficulty expanding the chest, pain in the neck, shoulders, knees, and ankles, low-grade fever, fatigue, and weight loss. There is no cure for AS, and the course of the disease is unpredictable. However, most patients can lead normal lives with treatment to control symptoms.
Celecoxib is licensed for use in these diseases. It was originally intended to relieve pain while minimizing the gastrointestinal adverse effects usually seen with conventional NSAIDs. Its use is primary indicated in patients who need regular and long term pain relief. It is recommended after taking into account all your medical history. Hence, it should be used under the supervision of your health care provider.
Written by: Bhupinder Kaur Khera
For free expert advice on safe, effective and assured quality medicines or to know more on meds for rheumatoid arthritis and ankylosing spondylosis visit: http://www.rx2gostore.com
Physio Treatment in Ankylosing Spondylitis
by Jonathan Blood Smyth
Ankylosing spondylitis is an inflammatory arthritic disease or spondyloarthropathy, classified with reactive arthritis, bowel disease arthritis and psoriatic arthritis. The underlying relationships between these diseases are complex but they are connected by enthesitis (inflammation of the ligament/bone junctions) and by possession of the HLA B27 gene on white blood cells. The enthesitis process at the joint edges can cause fibrosis and then ossification of the area (bone formation).
AS is the commonest of the spondyloarthropathies and its occurrence varies with the occurrence of the HLA B27 gene in the population, AS being less common in the tropics and more common in northern European countries. 0.1 to 1.0% of people are affected but this varies with latitude and is more common in white people. About 1-2% of people with the HLA B27 gene actually develop AS but this becomes 15-20% likelihood if they have a first degree relative with the disease.
Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.
Ankylosing spondylitis has similarities but distinct differences from the much more common low back pain:
Morning stiffness in the lumbar spine, lasting at least 30 minutes or longer Exercise improves the back pain and stiffness Rest worsens the pain and stiffness Pain is usually worse in the second half of the night, after a time of rest Peripheral joints are affected in 30 to 50% of patients Tiredness is common AS has systemic affects from its inflammatory nature which can include feeling unwell, fever and loss of weight.
Physiotherapy examination of the spine in an AS patient usually uncovers significantly reduced ranges of spinal movement from normal, with perhaps a reduced lumbar lordosis and an increased thoracic curve. Neck movements may also be limited in later stages and a reduction in chest expansion noted due to rib joint involvement. Peripheral symptoms occur in around a third of patients and the physio will palpate the tender areas, searching for evidence of enthesitis in the insertions of the Achilles tendon and plantar ligament of the foot. These are areas of high mechanical stress and commonly affected.
Postural analysis of the AS patient is the first thing a physiotherapist notes after the subjective examination, recording spinal abnormalities, flexed knees, rounded shoulders or poking head posture. The ranges of movement of the cervical, thoracic and lumbar spine are measured and a battery of standard measures taken which allows assessment of the disease progression. The hips or other peripheral joints may be affected and these need to be measured also, with the physio likely testing out sites where the enthesis is likely to be painful and inflamed. If the disease is active then the patient may also have joint effusions and may appear unwell, be sweating and not have slept well.
Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.
What is Ankylosing Spondylitis?
Ankylosing Spondylitis is a condition which is related to arthritis. Ankylosing Spondylitis affects approximately 1 in every 250 mainly young men so while many may have not heard about it, it is quite common.
The word Ankylosing means inflammation of the spine while Spondylitis means joint which is fixed solid and unable to bend. So, in simple terms, Ankylosing Spondylitis is a condition which involves the spine becoming inflamed and as a consequence becoming fixed and solid. What tends to happen, is that tendons or ligaments attached to the spine become swollen. When the swelling reduces, it is replaced by growths of bone. When this happens a number of times, there becomes more and more bone where there used to be tendons or ligaments until eventually the joint fuses together.
As with many conditions, different people are affected with varying degrees of this condition, with some barely noticing it while others lose their full independence. What is also interesting is that the Ankylosing Spondylitis symptoms can come and go over time.
What are the Symptoms of Ankylosing Spondylitis?
The first time people tend to notice that they have Ankylosing Spondylitis, is when the experience lower back pain and some muscle spasms. This tends to be worse during the night. This pain often spreads to the upper back, neck and buttocks. Also, in the morning, neck pain may be experienced which is relieved during the day through exercise.
Without treatment, it is possible that the symptoms could develop into fever, fatigue and a loss of appetite. There may be some weight loss as well.
As the spine starts to fuse together, you may start to find it more and more difficult and painful to move around. Also, in a number of cases. as the joints start to become more and more affected, it becomes harder to breath as the ribs start to stop moving. This means that breathing is now being conducted using only the muscles of the diaphragm. On top of this, the lungs could be affected by Ankylosing Spondylitis.
Ankylosing Spondylitis in approximately 1 in 3 cases can cause inflammation in one or both eyes.
Causes of Ankylosing Spondylitis
Nobody knows exactly what causes Ankylosing Spondylitis. It is generally thought that the antigen HLA-B27. This may explain why this condition appears to run in families. This is also linked to a condition called Reites Syndrome.
Treatment of Ankylosing Spondylitis
There are no drugs in existence today which can slow or stop the condition. However, there are drugs called Non Steroidal Anti Inflammatory Drugs (NSAIDs) which can help to control the inflammation and reduce the pain.
Also, daily exercise consisting of gentle stretching exercises or swimming can help to improve the movement of the spine and help to create a more positive posture. On top of this, hydrotherapy and physiotherapy can also help to relieve the symptoms.
Unfortunately, there are a small number of people suffering from Ankylosing Spondylitis who will require hip replacements. Thankfully, those cases are few and far between.
Interestingly, the symptoms of Ankylosing Spondylitis can be present for a period of time and then they reduce significantly.
Ankylosing spondylitis (AS) is a chronic, systemic, inflammatory form of arthritis that preferentially affects the spine leading to limitation of spine movement. The cause of AS is not fully known, but there is a strong genetic predisposition associated with a genetic marker called the human leukocyte antigen (HLA)-B27.
AS usually begins with back pain and stiffness in the late teen years and early adulthood due to inflammation of the sacroiliac joints (the joints that join the spine to the pelvis) and the spine. AS also has a tendency for affecting sites where ligaments attach to bone. When inflammation affects these areas, the condition is called “enthesitis.”
The most common joints outside of the spine and sacroiliac joints to be affected are the hip and shoulder joints. Other joints such as the knee, wrist, ankle, and elbow can also be involved. Some patients may develop eye inflammation termed “acute anterior uveitis”.
Involvement of the heart and lungs, while rare, can be a complication. There may also be an association with psoriasis or inflammatory bowel disease.
Males are affected twice as often as females. Onset of symptoms after age 45 is unusual. Roughly, 15% of patients have disease onset during childhood.
The earliest symptom can be a dull pain in the buttock region. This occurs as a result of sacroiliac joint involvement. Some patients may have radiation of pain down the upper part of the back of the thigh and be misdiagnosed as having sciatica.
The pain at first may be one-sided and intermittent. It may also alternate, first in one buttock and then the other, but the pain, over time, becomes persistent and involves both sides.
The low back area becomes stiff and painful. This may be accompanied by tenderness along the spine and in the sacroiliac joints.
The back symptoms tend to worsen after prolonged periods of rest so that a patient will say their worst times are late at night and early in the morning. The symptoms improve with physical activity or exercise and worsen with rest.
The back symptoms also worsen with exposure to cold or dampness. Some patients have fleeting aches and pains or tender spots that can lead to a misdiagnosis early on of fibromyalgia.
Sometimes, the first symptom can be pain and stiffness in the middle part of the spine (thoracic region) or even the neck. Sometimes chest pain may be more of a symptom than low back pain.
Eye inflammation in the form of anterior uveitis is the most common non-joint feature of AS. This complication occurs in 25%-40% of patients at some time during their disease.
Clinical examination may or may not be helpful in the early course of the disease. The physician should examine the sacroiliac joints and the entire spine, including the neck. Chest expansion (the ability to move the chest with a deep breath) along with range of motion of the hip and shoulder joints should be measured. A search for signs of enthesitis can be helpful in making an early diagnosis of AS. The areas to search for enthesitis include the spinous ligaments, pelvis, front chest wall, bottom of the heels, back of the heels (Achilles tendon), outside of the hips, and the front of the knees just below the kneecap. This area is called the tibial tubercle.
The muscles along the spine may also be tender.
As the disease progresses, the spine becomes stiffer leading to loss of mobility in all directions. Chest movement also becomes more restricted.
Spinal deformities slowly progress and make the spine more rigid. Some patients may develop osteoporosis. If osteoporosis accompanies the rigidity, then a particularly dangerous situation develops because this rigid osteoporotic spine is very susceptible to fracture even after minor trauma.
The diagnosis of AS is based on physical exam and confirmed by imaging procedures. Symptoms, family history, and the joint exam are the most important tools early on.
X-ray evidence of AS may not be evident early in the course of the disease. Patients may need to undergo magnetic resonance imaging (MRI). MRI can detect subtle inflammatory changes in the sacroiliac joints and other areas of enthesitis early on HLA-B27 typing can be helpful in cases where AS is suspected but the diagnosis remains uncertain.
In cases where AS suspected, the HLA-B27 test may allow the presumptive diagnosis of AS to be made.
However, the presence of HLA-B27 should not be used to diagnose AS in the absence of other supporting history and physical exam evidence.
Dr. Muhammad Khan, the world’s foremost expert in AS, has flatly stated that, “HLA-B27 testing is inappropriate in patients with back pain or arthritis in whom neither the history nor the physical examination suggests the presence of AS. A positive result in this clinical situation would still not permit the diagnosis of AS to be made because up to 8% of the general population possesses this gene.”
Laboratory tests measuring inflammation are of limited value. Elevation of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) occurs in about 70% of patients with active AS. The problem is that there is not a good correlation between the elevation in these blood tests and disease activity.
It may be that the increases in ESR and CRP reflect the presence of active arthritis in joints outside of the spine. Normal ESR or CRP does not exclude the presence of clinically active AS.
Successful treatment of AS requires a combination of non-drug as well as appropriate drug therapies.
Patient education is important and should include a life-long program of regular stretching and range-of-motion exercise. Smokers should be encouraged to stop smoking.
Use of non-steroidal anti-inflammatory drugs (NSAIDs) is often helpful. Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide (Arava), and sulfasalazine (Azulfidine), are not useful for the treatment of disease restricted to the spine. They may be helpful in patients where peripheral joint arthritis or enthesitis is present.
Tumor necrosis factor (TNF) inhibiting agents, etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) are very effective in treating AS patients.
MRI studies have shown that TNF-inhibitors are capable of resolving severe inflammation in the spine as well as in peripheral joints. Whether these drugs can prevent structural damage remains to be seen.
As with all forms of arthritis that require immunosuppressive therapy, close supervision of the patient is mandatory.
Surgery may be required for cases of AS that don’t respond to medical therapy. Joint replacement, in the case of peripheral involvement, and corrective spinal surgery may be needed.
Fortunately, today, quicker diagnosis and more aggressive medical intervention have reduced the need for surgical solutions.
One other note of caution… In patients with significant neck involvement and rigidity, intubation for general anesthesia is extremely difficult and dangerous. These patients should notify the anesthesiologist in cases of elective surgery. They should also wear an ID bracelet advising of their condition.
By: Irene Fowler-Sharpe
It is believed that up to one in one hundred people suffer from Ankylosing Spondylitis; a chronic inflammation of the spine. Recent research suggests that the ratio of men and women suffering from the disease is about equal. AS is mostly a disease of younger people; often beginning before the age of twenty years of age, while rarely affecting people who are over the age of forty.
AS is a type of chronic arthritis that mainly affects the spine. In AS, the inflammation occurs in joints and in areas where tendons and ligaments attach to bones. When the disease becomes more advanced, inflammation of the spine can actually cause the spinal vertebrae to fuse.
As with many types of arthritis, the cause of AS is not known. If someone in your immediate family has the disease;like a parent, or sister or brother; then your risk of getting the disease goes up by twenty percent.
Usually AS starts off gradually. The first symptoms of the disease are usually aches and pains in the lower back;which are caused by inflammation of the sacroiliac joints, located in the lower back on both sides of the spine,just above the buttocks. If you have lower back pain that begins gradually and persists for months could be an indication that you have AS. Sometimes the back ache can be so severe that it can interrupt your sleep.
Although AS usually starts in the lower back, as the disease progresses it can move to other joints as well; especially the neck, shoulders and the hips. The spine will become stiff due to the pain and muscle spasms. In the final stages of AS, chronic inflammation can cause bony ridges to form between the vertabrae, causing the spine to fuse permanently into a bent and inflexible position.
AS is known as a systemic disease, often affecting areas of the body beyond the joints. People with AS can experience weight loss, poor appetite, and fatigue as well as an inflammatory eye condition known as “iritis”.
Diagnosing AS can be a challanage for Doctors.There are several clues which Doctors will look for when they are trying to make a diagnosis of the disease. If a patient has had back pain which has developed gradually, if the person has stiffness in the morning when getting up, if the patient has been troubled continually for more than three months; and also if exercise helps to relieve the pain. The Doctor will also give a physical exam to determine the patients flexibility; he may also press on the patients sacroliac joints to see if they are tender.
Besides the physical examination, the Doctor may order Lab tests and X-rays to determine if the disease is present.
On the brighter side of things; people who have AS usually lead normal lives. They have to take charge of the situation and include exercise in their daily routine. Regular activity enables AS patients to maintain a limber spine and prevents spinal deformity. Daily stretching exercises for the spine are especially recommended. Swimming is another great exercise for people with AS. Maintaining good posture is a prerequisite. Also, sleeping on a firm mattress is recommended.
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