Ankylosing Spondylitis

Dr.AhmadDr.Ahmad مدير عام
What Causes Ankylosing Spondylitis?
The cause of ankylosing spondylitis is not known. However there is a strong genetic or family link. AS is
far more common in people who inherit the white cell blood group HLA B27 than in those individuals
who do not have this blood group. It is not related to the red cell blood groups which are important in
blood transfusions. Some researchers believe that the body's natural defense system, the immune system,
may also have a defect which promotes the development of AS.
Who Gets Ankylosing Spondylitis?
AS usually affects men between the ages of 16 and 35. In the United States of America about one percent
of the population is affected. In females the disease is often mild and not so easily diagnosed. At present
no figures for the local population are available.
What are the Symptoms of Ankylosing Spondylitis?
The most common early symptoms of AS are constant low back pain and hip pain and stiffness which
persist for more than three months.
Back problems are one of the most common complaints that are seen in the clinic and are mostly due to
"back strain", "slipped disc" or wear and tear problems associated with aging.
Useful symptoms which help to separate AS from other causes of back pain are:
• slow onset over weeks and months lasting for more than 3 months
• onset before the age of 40 years
• stiffness and pain in the early morning
• improvement with exercise, worsening with rest
The inflammation in AS can also affect the joints between the ribs and the back bone or breast bone
causing chest pain. The shoulders, knees, ankles and heels can also be affected.
Patients with active disease can feel tired, have fever and lose appetite and weight. Occasionally
inflammation of the eye can occur. Rarely heart or lung involvement can develop. It is uncommon for all
these problems to happen in the same person.
The Diagnosis of Ankylosing Spondylitis
There is no diagnostic test that your doctor can do at the onset of back pain. However the symptoms
would alert him to the possibility of AS. Testing for the HLA B27 blood group may help to make the
diagnosis in early disease. Non-specific tests which indicate the presence of inflammation of the spine
include the erythrocyte sedimentation rate (ESR) and the haemoglobin (Hb) level. The characteristic
changes in the sacroiliac joints take months to years to develop but when they are present the diagnosis is
What is the End Result?
The symptoms for AS is not the same for all people. Usually the symptoms come and go over long
periods of time but almost always settle down in the end. The lumbar spine usually becomes stiff and the
rest of the spine can also be affected in the same way. For this reason it is very important to maintain a
good posture so that serious deformities can be prevented.
Treatment and Management
Treatment is designed to reduce pain and stiffness so that normal activities can be continued. Your doctor,
physiotherapist, occupational therapist and others involved in your care will help you find the best way to
manage your disease. Bear in mind that what works for others may not work for you. Be patient and
actively take part in your own treatment.
Remember: It is the doctor's job to relieve pain and the patient's job to keep exercising and to maintain a
good posture.
Not every patient will return to normal, even if the exercises are followed, but serious deformities can be
prevented. Even though a cure is not available at present, you can do a lot to prevent major problems from
• Maintaining a good posture is important at all times, whether sleeping, sitting or standing, so that
the joints do not fuse in undesirable positions.
• Every effort must be made to keep the spine straight as AS tends to cause flexion of the spine,
especially if not treated.
• It is rare for the spine to stiffen completely, but if this should happen, the patient should do
everything he can to stiffen in a straight rather than bent position.
• A period of rest in hospital or at home may be needed if the AS is very active and you are
experiencing a lot of pain and stiffness. However you must still continue to exercise your chest,
back and limbs to keep them supple.
• When lying in bed it is important to lie flat on your back. Some time should also be spent lying
on your face (prone position). You could do this for 20 minutes before getting up in the mornings
and for 20 minutes before going to bed at night.
• If you do this regularly it will help prevent your back and hips from becoming bent.
Your Bed
• Your mattress should be firm to prevent any tendency for spinal curvature from developing later.
If you find that it is too yielding you can put a sheet of plywood or chipboard 70 x 150 x 1 cm
between the mattress and the bed frame.
• If you are traveling and find that the bed in the hotel is too soft you could pull the mattress off the
bed onto the floor and sleep on that.
• High chairs with a firm seat and upright firm back are better for keeping the spine in a good
posture. The seat of the chair should not be too long otherwise you will find difficulty positioning
your lower back into the base of the chair back.
• Do not spend time sitting in low soft chairs as they will result in bad posture and increased pain.
At Work
• Pay attention to the position of your back when at work. A job that allows you to change from
sitting to standing and walking from time to time is the most suitable. When seated at a desk or
bench, adjust your seat to the proper height and try to move your back from time to time. The
most unsuitable job is one where you have to stoop or crouch over a bench for long periods.
• If you have physically demanding activities try to have a break before doing other activities at
home or elsewhere. Resting flat for 20 minutes at midday is also helpful. Try also to lie for part of
this time in the prone position.
• If you have a job that involves a lot of stooping or back strain talk this over with your doctor. He
may be able to advise you or help you change to more suitable work. Some AS sufferers have
found it useful to show this booklet to their doctors or employers in explaining their needs.
• Your doctor or physiotherapist will suggest a program of exercise to be done every day. This will
help you keep posture and activity as normal as possible. Exercise helps to reduce stiffness and to
strengthen the muscles surrounding the joints.
• If you sometimes feel too stiff and sore to exercise try taking a hot bath or shower to loosen up.
Start the exercises slowly and plan them for times of the day when you are least tired and have
the least pain. This way you will gain the most benefit from your exercises.
Medical Management
• Although there is no cure for AS much can be done to help you to have a normal social and
working life. The doctor aims to relieve pain and stiffness so that you can do exercises to help
prevent deformities and disability. You, your doctor and your physiotherapist all play an active
role in the management of your illness.
• AS tends to settle down as you grow older but you should realise that treatment has to continue,
although you may not have to visit your doctor so frequently.
• Drugs help to relieve pain and stiffness although they cannot cure AS. Your doctor will probably
first prescribe a drug from the class of drugs known as non-steroidal anti-inflammatory drugs
(NSAIDs). Indomethacin is one of the most effective of these drugs. However it can cause
"gastric" symptoms such as indigestion and heartburn especially if taken on an empty stomach.
Some other side effects include dizziness, headache and a "light-headed" feeling.
• There are many other NSAIDs available which may work for you. Talk with your doctor about
how you should take your medications, what side effects they can cause and what to do should
these side effects occur.
• Sulphasalazine (Salazopyrin) is a drug which acts to control disease activity. It is sometimes
prescribed, especially when arthritis of the limb joints is troublesome. It does not relieve pain
immediately and you should continue to take it as prescribed for a period of time to allow it to
work. The side effects include rashes and anemia. It cannot be used in men who are planning to
have children as it affects the sperm count, although this returns to normal once the drug is
Surgery has only a small part in management. It is used to restore movement to joints which have been
damaged by arthritis. Artificial joint replacement surgery of the hips (hip arthroplasty) and spinal surgery
are sometimes done.
Other Treatment
• People with AS should stop smoking because AS itself causes reduced chest expansion and can
be complicated by lung involvement.
• If you have any problems with your eyes such as a painful or red eye or reduced vision you
should not delay seeing an ophthalmologist (eye doctor) for iritis. Iritis is a painful condition
resulting from inflammation of the coloured part of the eye called the iris.
Ankylosing Spondylitis and the Family
Almost all sufferers of AS have the white blood cell group HLA B27 but the reverse is not true. There are
far more people with this blood group who never get AS than those who get it.
If I Have Ankylosing Spondylitis, Will My Children Get It Too?
From the present evidence about 20 percent of people with HLA B27 will get ankylosing spondylitis,
although most will not be diagnosed because the disease is very mild. The chance of your children getting
AS is quite low, being not more than 15 percent. Of these 15 percent only one will have disease severe
enough to interfere with a normal life. Parents sometimes ask if they should have their children tested for
HLA B27. At present the answer is no since there is no way of predicting which child with the blood
group will get the disease.
Ankylosing spondylitis does not usually interfere with lovemaking unless the hips are affected. One of the
most important aspects of a good sexual relationship is communication. If you and your partner can
comfortably discuss both of your needs, difficulties can be overcome.
Pregnancy for the woman with AS is usually no different from a normal person. Sometimes a Caesarean
operation is needed if the hip joints are very rigid.
People who develop a chronic (long-standing) disease such as AS often go through many emotional ups
and downs. You may need to make changes in your life and this can leave you feeling depressed and
angry. It often helps to talk about these feelings to family members, a close friend or someone else who
has spondylitis. You might also want to talk to a counselor who can help you deal with these feelings.
Car Driving
Patients with stiffness of the neck or other parts of their spine often have difficulty backing theirs cars into
a parking lot. Special mirrors could be fitted onto your car to help you. It is important to practice parking
using these new attachments. Head rests are also advised to avoid sudden injuries to the neck as the stiff
neck of an AS patient is more easily injured than a normal neck.
Life Insurance
Many life insurance companies do not fully understand AS and will automatically have a loading factor
included in the policy. AS patients could shop around for an insurance company which is more
sympathetic towards this disease.
Sporting Activities
The most suitable activity is swimming since the muscles and joints are used without being jarred.
Contact sports are not recommended since the joints can be injured.
Jogging and distance running are enjoyed by many young patients. Badminton and tennis can be
beneficial as can basketball, netball and volleyball since all combine movements with stretching.
Bicycling is also good as it helps to keep the joints active besides providing breathing exercise.
Folk Remedies
There is no evidence that acupuncture or other traditional remedies are useful in AS. Don't be swayed into
trying expensive forms of treatment which are not proven. Manipulation of the neck can be dangerous
when the neck is stiff.
The Future
People with ankylosing spondylitis can expect to lead fairly normal lives. Only a few will suffer severe
disability. Ankylosing spondylitis is not curable but it can be controlled so that it will not interfere with an
active and useful life.


  • تم تعديل 2009/04/07
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