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What is Ankylosing spondylitis?

Article by Dr Peter Richard Pedersen

Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammation of the vertebal column (the spine) at the joints where vertebrae join each other. This inflammatory disease also affects the hips, shoulders and ribs. It usually begins in the late teens or early twenties. The disease is diagnosed more frequently in males than in females. In most cases, ankylosing spondylitis is a mild condition that goes undiagnosed for decades. There can be a hereditary tendency to develop the disease. The cause is unknown, but is suspected to be an autoimmune disease.

HOW IS IT DIAGNOSED?

History:

Chronic low back pain and stiffness are typically the first symptoms of ankylosing spondylitis. Pain is characteristically worse with rest and improves with activity. Symptoms develop gradually, so that individuals often cannot report when it began. There is not a history of injury. There may be a family history of this disease or some "arthritis of the spine." Frequently heard, the statement "my dad had a bad back".

Physical exam:

The earliest physical finding in ankylosing spondylitis is usually tenderness over the sacroiliac joints. As the disease progresses, the spine becomes more rigid and bending in any direction becomes more restricted. When the disease has advanced to the thoracic spine, chest expansion becomes restricted. The individual's posture becomes "stooped."

In later stages of the disease, pain and stiffness in neck (cervical) joints and muscles occur, so that the neck cannot be fully extended and eventually the neck becomes fixed in a bent-forward (flexed) position.

Tests:

Routine lab tests are normal. The disease may be suspected by the presence of an antigen (HLA-B27) in the blood. Early x-ray changes are sacroiliac joint rarefaction (localized osteoporosis) and "squaring" of the vertebral bodies. A CT scan can detect sacroiliac changes early in the disease. Later, sclerosis of these joints is evident on plain x-rays and osteophytes that bridge from (fuse) one vertebral body to another is visible. The most common finding on medical x-rays is "no abnormality detected" and if your doctor is relying on the radiologists report for his/her information...you will be told "there is nothing wrong with you" or "nothing on your x-rays".

HOW IS IT USUALLY TREATED?

Medically, anti-inflammatory drugs are used to relieve the chronic pain and stiffness. If there is no response to this type of treatment, drugs to suppress the immune response will be added. Shotgun approach without regard to the consequences.

Natural therapists have less harmfull solutions for pain and inflammation. Herbal and potent nutritional supplements are more effective than harmful drugs, not only in the reduction of pain, but also in the preventive and restorative qualities.

Therapy and stretching exercises can be used to offset the reduced flexibility of the disease. Pool exercise, deep breathing exercise and thoracic extension exercises are helpful. Surgery might be needed to correct severe spine disease or stooped-over posture (hump back) or to replace damaged hip joints. Our treatment consists of myotherapy, massage, chiropractic and osteopathy as indicated, active and passive stretching, frequency specific microcurrent (FSM), acupuncture, nutritional intervention, herbal medicine and exercise physiology. We are interventionists, we do not accept the blind view of the medical profession (no cure), we are in active pursuit of cure!

WHAT MIGHT COMPLICATE IT?

Fractures of the spine can occur without any injury. Heart disease occurs in a small minority of individuals with long standing, severe disease. Inflammation of the eye (anterior uveitis) is associated in as many as 25% of cases. Formation of fibrous tissue in the lungs (pulmonary fibrosis) may occur, usually long after the onset of skeletal symptoms. Pneumonia is more common than in the general population. This is due to the auto immune aspects of the condition and prevention of progression can ONLY be obtained with early intervention. Don't wait for symptoms to develop, they will. Seek alternatives as soon as you have a diagnosis!

WHAT IS THE PREDICTED OUTCOME?

The majority of individuals with ankylosing spondylitis are able to live normal lives. In recent studies, only ten to twenty percent become significantly disabled over a period of 20 to 40 years. A pattern of disease progression usually emerges after the first ten years. Early interventional measures are the best prevention!

WHAT ARE POSSIBLE WORK RESTRICTIONS AND ACCOMMODATIONS?

The stage and severity of the disease will determine the need for modifications in the work environment. For most individuals, early stage symptoms are manageable and few, if any, restrictions are required. Adjustment of the work station to permit use of proper posture is helpful.

WHAT ELSE MIGHT IT BE?

Other disorders that have common presenting features are Reiter's syndrome, psoriatic arthritis and the arthritis associated with inflammatory bowel disease. There are many other causes of spine pain that don't involve inflammation of the joints between vertebrae.

WHAT ARE THE FACTORS THAT MIGHT INFLUENCE LENGTH OF DISABILITY?

A compliant and well-educated individual will manage the disease more readily. Many who suffer this condition will waste a lot of time and money having massage for a sore back or attempting unsupervised exercise to answer back stiffness or back pain.
Lifestyle modifications are essential in the effort to preserve mobility and limit further disability. A profound improvement is noted when daily exercise is initiated. Jogging, running or other impact exercises are not beneficial.
Smoking is discouraged because the disorder can eventually limit air exchange due to its effects on the rib cage.

The appearance of hip involvement in the early stage of disease is an indicator of a poor prognosis. This may be due to early immobility or severe low back pain or even psychological causes relating to "getting old". Back pain, back stiffness, poor mobility...these are reasons to feel old, but the consequence of prematurely reducing activity are dire.

Ankylosing spondylitis is a progressive disease with individual differences in the rate of progression and degree of disability.

Moderate active disease or deformity is sometimes considered disabling.

 

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