Ankylosing Spondylitis (AS)
A collection of information and links
I started for reference.
Form of Arthritis of the spine. Exact cause is unknown.
Many people with ankylosing spondylitis have other family members with it. Possibly hereditary.
"I'm no longer prepared to live with the disease
but the disease "is going to have to live with me". - Valli Moosa
This material is designed for information purposes only.
It should not be used in place of medical advice, instruction and/or treatment.
If you have specific questions, please consult your doctor or appropriate health care professional.
Ankylosing spondylitis (AS) is an inflammatory condition that mostly affects the spine. The condition causes chronic pain and stiffness, especially in the area where the back joins the hips. In the early stages, patients may experience a gradual onset of pain and stiffness in the lower back. The symptoms are most apparent at night or in the early morning hours. Eventually, the pain can spread through the whole spine and radiate down the back of the buttocks and thighs. Muscle spasms and pain can interfere with quality sleep and cause extreme fatigue. In some cases, the disease can affect other joints as well, like those in the shoulders, knees, ankles and neck. Eventually, patients may experience loss of motion and deformity in the affected joints. In severe cases, patients develop eye irritation, heart valve abnormalities, inflammation of the aorta and lung fibrosis.
According to the Spondylitis Association of America, up to one million Americans have AS or a related disease. The condition is three to four times more common in men than in women. Signs typically appear in young adulthood – usually before 30 or 35. Because the symptoms are vague and often localized to the back area, many patients are initially misdiagnosed as having back pain. Research suggests it takes an average of 10 years from the onset of symptoms until patients are correctly diagnosed.
Traditionally, the main treatment for AS has been nonsteroidal anti-inflammatory drugs to reduce pain and stiffness. If these medications are ineffective or cause side effects, other drugs may be tried, like sulfasalazine, methotrexate and corticosteroids. Exercise is necessary to maintain joint flexibility and range of motion. Proper posture is important to reduce strain on the spine. In addition, some patients benefit from weight control (avoiding excess weight gain), heat or cold therapy, ultrasound, gentle massage or transcutaneous electric nerve stimulation (TENS).
Researchers have discovered a biological therapy for AS called, anti-tumor necrosis factor alpha (TNF). Tumor necrosis factor is a natural chemical that plays a role in the development of inflammation. Anti-TNF medications bind to and inactivate the TNF molecules, blocking the chain of events that lead to inflammation. Research suggests anti-TNF therapy significantly reduces symptoms of AS and can slow progression of joint destruction. About 80 percent of patients respond to the therapy, but the best results are seen in patients with early-stage disease. Complete remission is rare.
In July, the FDA approved the arthritis drug, etanercept (Enbrel®) as the first biological therapy for AS. Two other anti-TNF medications, infliximab (Remicade®) and adalimumab (HUMIRA™), are still only approved for arthritis, but may be used off-label for AS. Anti-TNF drugs are expensive (more than $10,000/year) and may not be completely covered by health insurance. Patients who take the medication may be at risk of infection and hypersensitivity to the drug or its components. Anti-TNF drugs can’t be used by patients with congestive heart failure.
For general information on ankylosing spondylitis:
American College of Rheumatology, http://www.rheumatology.org
Arthritis Foundation, contact your local chapter, or visit their website at http://www.arthritis.org
Spondylitis Association of America, PO Box 5872, Sherman Oaks, CA 91413, http://www.spondylitis.org
For information about the anti-TNF drugs:
Enbrel® - http://www.enbrel.com
Remicade® - http://www.remicade.com
HUMIRA™ - http://www.humira.com
Source: Laura Michels - http://www.hoinews.com/news/features/4/517262.html
Exams and Tests
A medical history, physical examination, and laboratory tests are used to diagnose ankylosing spondylitis.
A medical history is used to evaluate symptoms. Most people with ankylosing spondylitis have back pain with 4 to 5 of the following characteristics:
You will also be given a physical examination to evaluate the stiffness in your back and the ability to expand your chest normally. You may experience chest pain and stiffness with ankylosing spondylitis. A few people may also develop jaw pain (temporal mandibular joint) problems along with ankylosing spondylitis.
Laboratory tests used to diagnose ankylosing spondylitis include:
Ankylosing spondylitis is a disease within a family of diseases called spondyloarthropathies. Examples of other spondyloarthropathies include psoriatic arthritis, Reiter's syndrome, and inflammatory bowel disease arthritis. It is possible to be diagnosed with an unclassifiable form of spondyloarthropathy. These conditions have similar characteristics but distinct features and prognoses. Your doctor will try to determine which type of spondyloarthropathy you have for proper treatment. Ankylosing spondylitis can be a more severe form of the spondyloarthropathies.