Ankylosing spondylitis (AS) is a chronic form of arthritis that flares up in the sacroiliac joint of the lower spine and pelvis. AS almost always affects other parts of the body as well, including the rib and spine junction, hips, shoulders and neck, and can even involve the eyes, lungs and heart. A distinguishing characteristic of advanced AS is the fusing of the spine over time, which can cause permanent immobility and a stooped appearance in the most severe cases.
Symptoms
Like many forms of arthritis, AS first appears as persistent pain, stiffness and inflammation in the lower back or hips that is worse first thing in the morning or later at night. These symptoms usually ease up with exercise or any type of physical activity.
Other symptoms include limited spine mobility which may result in difficulty standing and walking, fatigue, loss of appetite and resulting weight loss, eye inflammation with pain, blurry vision, and light sensitivity, or a history of gastrointestinal disorders, such as ulcerative colitis or Crohn's Disease. Breathing can become difficult if inflammation spreads to the rib cage, causing rib bones to fuse and become immobile.
Risk Factors
At least half a million Americans have AS, and the condition affects more men than women, according to the Spondylitis Association of America. AS appears to have a genetic basis, so anyone who has a family history of the disease is at risk. Unlike most other forms of arthritis that develop in older people, AS most commonly occurs between the ages of 17 and 35.
Diagnosis
Early diagnosis can help prevent some symptoms from worsening. A doctor will perform a complete physical exam that includes X-rays, a review of family history, and a blood test for the genetic marker HLA-B27 found in many (but not all) people who have AS.
Prognosis
AS is a lifelong condition for everyone who is affected, but the degree of disease progression varies from person to person. Some people will have minor pain from time to time while others will suffer progressively more debilitating pain and spinal fusion over the course of their lifetime.
Treatment
There is no cure for AS but treatment, including medication and physical therapy, can reduce your pain and other symptoms and might help slow down or prevent progression of the disease. Medications include the stronger nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) and naproxen (Aleve); diseases-modifying antirheumatic drugs (DMARDs) such as methotrexate (Rheumatrex); corticosteroids and tumor necrosis factor (TNF) blockers. Physical therapy can help improve breathing, flexibility, strength and range of motion, and also improve posture to help prevent the spine from fusing in a stooped over position.
