Ankylosing Spondylitis (AS)
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Ankylosing Spondylitis (AS)

Symptoms of Ankylosing Spondylitis usually start with chronic lower back pain. Onset is often before the age of 30 and early treatment is critical.

Ankylosing Spondylitis also called Spondyloarthritis mainly affects the spine and sacroiliac but can affect other joints and organs as well. It is a condition that affects 2.4 million individuals in the United States according to the Center for Disease Control and Prevention. Ankylosing Spodylitis is diagnosed three times more often in men than in women.

Early diagnosis is extremely important to prevent or minimize irreversible damage to joints and organs. Oftentimes a doctor will make a presumptive diagnosis before a firm confirmation can be made of the disease. This can lead to important treatment in the early stages that may enhance function and improve outcomes.

Symptoms of Ankylosing Spondylitis (AS)

Onset of symptoms usually begin before age thirty and can be as early as the teen years. Generally symptoms appear some time between twenty and fourty years of age.

In the beginning stages there is usually chronic pain in the lower back and pelvis region. Sometimes pain is in the buttocks and back of thighs and heels. Chronic fatigue is common.

Pain and stiffness continues to move up the spine, neck and chest. Other joints may become involved such as the hips, shoulders, knees, heels and ankles. Inflammation of the eyes is another symptom that some may have.

Limited movement may be experienced in the back and it may be difficult to expand the chest due to involvement of the vertebrae where the ribs attach (costovertebral joint).

Advanced symptoms may include deformity of the hips and spine with eventual fusion of the spine (called bamboo spine) in very advance cases.

While some forms of arthritis do better with rest, Ankylosing Spondylitis shows some relief and improvement with exercise and stretching.

Diagnosis

Diagnosis of Ankylosing Spondylitis in the very early stages is primarily done by symptoms and patient complaints. This diagnosis is called presumptive (they presume that is what you have) because the changes in the skeletal system may not show up for months or possibly years on x-ray.

Later x-rays may show changes in the sacroiliac joint and fusion in the spine. This confirms the presumptive diagnoses. Other imaging tests may be done such as CT scans and MRI scans.

There is a genetic marker that will contribute to a diagnosis. The HLA - B27 gene is found in 95% of Caucasians and 50% of African Americans who have AS. This genetic marker occurs in 8% of the population but only 2% of that population will actually get the disease.

Blood tests are not all that helpful in determining a confirmed diagnosis of Ankylosing Spondylitis. AS does not show the typical blood indicators of other forms of arthritis such as an elevated sedimentation rate showing inflammation, rheumatoid factor (Rheumatoid Arthritis) or the antinuclear antibodies (Lupus).

Treatment

Alternative treatments may include:

  • Acupuncture
  • Massage
  • TENS unit treatments for pain relief
  • Yoga to maintain flexibility
  • Oriental exercise programs such as Tai Chi and Qigong
  • Diet, nutrition and supplements

Chiropractic treatment is not recommeded for Spondylitis.

Traditional treatments may include:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as Ibuprofen
  • COX-2 inhibitors (or COXIBs) such as celebrex
  • Other anti-inflammatory and pain medication
  • Steroids
  • Tumor-Necrosis-Factor inhibitors (TNF) such as Humira

Resources:

HealthCentral.com Encylopedia of Diseases and Conditions: Ankylosing Spondylitis

National Library of Medicine National Institute of Health: Health Topic Ankylosing Spondylitis

Spondylitis Association of America

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