ANKYLOSING SPONDYLITIS

BACKGROUND

Ankylosing spondylitis (AS) is a disease that causes pain and stiffness in the back, neck, and sometimes hips and heels. It begins with inflammation around the bones in the spine or in some joints. Later, it can sometimes cause the bones in the spine to fuse together.

DISEASE OCCURRENCE IN POPULATION:

Ankylosing spondylitis prevalence in Pakistan could be between 0.5 to 1% of the population.

It occurs in 0.1-1% of the general population, with the highest prevalence in northern European countries and the lowest in sub-Saharan Africa.

RISK FACTORS:

GENDER: Men are more likely to develop ankylosing spondylitis than are women.

AGE: Onset generally occurs in late adolescence or early adulthood.

HEREDITY: Most people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis.

SIGN AND SYMPTOMS:

The most common symptom is pain in the low back. This pain usually:

• Starts in early adulthood, usually before the age of 45
• Comes on slowly
• Lasts for more than 3 months
• Is worse after resting, such as first thing in the morning
• Feels better with movement

The back might also become less flexible. This can make it harder to do things like bend forward to put on socks or shoes. It can also lead to a “hunchback” posture over time.

Other symptoms might include:

• Pain or arthritis in other joints, such as the hips or shoulders
• Pain or swelling in other parts of the body, such as the elbows, heels, or ribs
• Feeling tired and not well

In some cases, ankylosing spondylitis can lead to other problems, such as:

• Inflammation of part of the eye – This is called “iritis” or “uveitis,” and causes eye pain and blurry vision.
• Problems with the spinal cord – Ankylosing spondylitis makes it more likely that the bones in the neck or back will break. This can sometimes happen even from a very small fall or accident. If these bones break, the spinal cord can be injured.
• Problems with the way the heart valves work
• Breathing problems – Some people have stiffness between the ribs and spine. This can make it harder to breathe deeply and to exercise.
• Inflammation of the inside of the intestines, which usually does not cause any obvious symptoms.

DIAGNOSTIC TEST:

No. There is no one test that can tell if you have ankylosing spondylitis. But your doctor or nurse should be able to tell if you have it by learning about your symptoms, doing an exam, and using imaging tests to look at your bones and joints.

TREATMENT OPTIONS:

Treatment depends on your symptoms and how severe your condition is. The goal of treatment is to relieve your symptoms, help you do your normal activities, and keep your condition from causing other problems.

Exercise is an important part of treating ankylosing spondylitis. Some people work with a physical therapist (an exercise expert) to learn the best way to exercise. You might do stretches and gentle exercises to strengthen your muscles. It is especially important to work on your posture. That’s because ankylosing spondylitis can cause the head to tilt forward in a “hunchback” posture. Special exercises can help prevent this.

Many people with ankylosing spondylitis also take one or more medicines. These might include:

• NSAIDs – This is a large group of medicines that includesibuprofen and  These medicines can help relieve pain and stiffness.
• Other medicines – There are other medicines that can help treat symptoms and keep ankylosing spondylitis from getting worse. Your doctor or nurse will decide which medicines are best for you.

Surgery can help some people with severe ankylosing spondylitis. For instance, some people have hip replacement surgery to replace a bad hip joint.

PRECAUTIONS:

If you smoke, quit. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis. Depending on the severity of your condition, ankylosing spondylitis can affect the mobility of your rib cage. Damaging your lungs by smoking can further compromise your ability to breathe.

REFERENCES:

• https://www.uptodate.com/contents/ankylosing-spondylitis-the-basics?source=see_link
• Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors.Arthritis Rheum. 1998 Jan. 41(1):58-67.
• Trontzas P, Andrianakos A, Miyakis S, et al. Seronegative spondyloarthropathies in Greece: a population-based study of prevalence, clinical pattern, and management. The ESORDIG study.Clin Rheumatol. 2005 Nov. 24(6):583-9.
• De Angelis R, Salaffi F, Grassi W. Prevalence of spondyloarthropathies in an Italian population sample: a regional community-based study.Scand J Rheumatol. 2007 Jan-Feb. 36(1):14-21.
• Reveille JD, Ball EJ, Khan MA. HLA-B27 and genetic predisposing factors in spondyloarthropathies.Curr Opin Rheumatol. 2001 Jul. 13(4):265-72
• Taurog JD. The mystery of HLA-B27: if it isn't one thing, it's another.Arthritis Rheum. 2007 Aug. 56(8):2478-81.
• http://www.pulsepakistan.com/index.php/main-news-may-1-15/1160-ankylosing-spondylitis-has-insidious-onset-and-back-pain-is-the-first-symptom-prof-asim-khan
• http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/risk-factors/con-20019766