Ankylosing Spondylitis

ALSO KNOWN AS

Marie-Strumpell disease or rheumatoid spondylitis

DESCRIPTION

* Ankylosing spondylitis is a chronic inflammatory disease of the joints of the spine and those connecting to the spine, such as the sacroiliac joint. This is an arthritic condition involving stiffness in joints, with resultant pain and stiffness in the back and hips, and difficulty taking deep breaths, due to rib connection to spine. The underlying cause is thought to involve the autoimmune response (the body's immune system mistakenly attacks these joints). The age of onset is usually late teens or early 20's, with a male predominance.

SYMPTOMS

* Morning stiffness
* Hip and shoulder pain
* Stiffness improves with activity
* Intermittent bouts of lower back pain (that may radiate to thighs)
* Progressive limitation of back motion
* Difficulty with chest expansion ("taking a deep breath") -- pleuritic chest pain is common
* Arthritis (stiffness and/or pain) in other joints such as hips, shoulders, and knees
* Uveitis (blurred vision, tearing, and light causes eye pain)
* Rarely, heart and lungs may be affected.
* Aortic root dilation
* Aortic Regurgitation



CAUSE

* Probable autoimmune (explained above)
* Genetic predisposition in those who carry the HLA-B27 gene

HOW THE DIAGNOSIS IS MADE

* Laboratory Tests:

1. Elevated Erythrocyte sedimentation rate (ESR)
2. Mild Anemia
3. HLA-B27 positive in 90% of cases
4. Absent Rheumatoid factor

* Imaging

1. Sacroiliac joint (spine connection to pelvic bone) is abnormal on X-Ray and CT scan
2. Spine X-Rays are abnormal ("bamboo spine" appearance)

TREATMENT

* Educational/emotional support
* Physical and occupational therapy
* Nonsteroidal anti-inflammatories, especially indomethacin
* Sulfasalazine



SIMILAR CONDITIONS

* Reiter's Syndrome
* Rheumatoid Arthritis
* Osteoporosis
* Herniated disc(s) of spine
* Back Injury
* Lumbar Spinal Stenosis