Ankylosing Spondylitis
ETIOLOGY/ PATHOPHYSIOLOGY
Ankylosing spondylitis is a form of
arthritis that is long-lasting (chronic)
and most often affects the spine . It
can cause pain, stiffness, swelling,
and limited motion in the low back,
middle back, and neck, and
sometimes areas such as the jaw,
shoulders, hips, knees, and heels.
Ankylosing spondylitis is more
common in men than women.
CLINICAL MANIFESTATIONS
inflammation primarily of the joints of the
spine, but it can also involve inflammation
of the eye, other joints (especially the hips)
on occasion, the heart, lungs, and chest
wall. If the inflammation continues over
time, it will lead to scarring and permanent
damage.
In some people, the disease is mild and
progresses slowly, and symptoms never
become severe. Other people may have a
more aggressive disease process.
Mild or early Ankylosing
Spondylitis
usually starts with dull pain in the
low back and back stiffness. Some
people have "flares" of increased
pain and stiffness that may last for
several weeks before decreasing
again.
Mild or early Ankylosing
Spondylitis
Affected bones of the low back,
middle back, hips, or neck may
become painful, stiff, and limited in
motion. Pain tends to increase
slowly over a period of weeks or
months, and it is often hard to
point to exactly where the pain is.
Stiffness is usually worse in the
morning. Physical activity often
helps decrease pain and stiffness.
Mild or early Ankylosing
Spondylitis
A feeling of tiredness is common as
the disease progresses. This
tiredness comes from the body
fighting the inflammatory process that
is part of ankylosing spondylitis, and
from ongoing stiffness and pain.
Mild or early Ankylosing
Spondylitis
The colored part of the eye (iris) may
become inflamed. This inflammation,
called iritis, occurs in about 25% to
30% of people with ankylosing
spondylitis.Symptoms of iritis include
redness and pain in the eye and
sensitivity to light.
Severe or advanced ankylosing
spondylitis
Scarring in the spine causes the joints
of the spine to grow together (fuse, or
"ankylose"). As the bones fuse , back
pain will gradually go away, but the
spine will remain very stiff and unable
to bend. The fused spine is more
likely to break.
Severe or advanced ankylosing
spondylitis
The upper spine can curve forward
until eventually the person has a hard
time looking straight ahead. In
addition, as the spine loses its natural
curves it becomes hard to balance for
standing and walking, especially if the
hips are also affected.
Severe or advanced ankylosing
spondylitis
Breathing can become difficult as the
upper body curves forward and the
chest wall stiffens. Severe ankylosing
spondylitis can also cause scarring of
the lungs (pulmonary fibrosis) and an
increased risk of lung infection. This
can cause even greater problems in
smokers because their lungs are
already more prone to lung infection
and scarring.
Severe or advanced ankylosing
spondylitis
Scarring in the eye can lead to permanent
visual impairment and glaucoma.
In rare cases, the heart muscle can
become scarred and the heart valves may
become inflamed. The heart may be
unable to pump properly (heart failure).
The main artery leading from the heart
(aorta) can also be affected by becoming
inflamed and enlarged near where it leaves
the heart.
DIAGNOSIS/TREATMENT
X-rays of the spine and pelvis to check for
bone changes (bony erosions, fusion, or
calcification of the spine and sacroiliac
joints). Certain changes in the sacroiliac
joint confirm the diagnosis of ankylosing
spondylitis, but those changes can take
several years to develop enough to show
on X-ray. MRI and ultrasound are both
being studied as ways to diagnose
ankylosing spondylitis earlier.
DIAGNOSIS/TREATMENT
A genetic test (through a blood test), which
may be done to determine the presence of
a particular gene (HLA-B27) that is often
associated with ankylosing spondylitis. This
test will not confirm whether you have
ankylosing spondylitis. However, if you
have the HLA-B27 gene, you could pass it
along to your children. This would increase
the chances they could get ankylosing
spondylitis or one of the other
spondyloarthropathies.
DIAGNOSIS/TREATMENT
You will have a physical exam to see
how stiff your back is and whether
you can expand your chest normally.
Your doctor will also look for tender
areas, especially over the points of
the spine, the pelvis, the areas where
your ribs join your breastbone, and
your heels.
INTERVENTIONS/TEACHING
Reducing pain by taking pain relievers
such as nonsteroidal anti-inflammatory
drugs, or using heat to decrease your pain
and stiffness. Warm showers or baths or
sleeping under a warm electric blanket may
reduce stiffness.
Exercising regularly. This reduces pain and
stiffness and helps maintain fitness and
mobility of the spine, chest, and joints. Your
doctor may recommend physical therapy to
get you started on an exercise program.
INTERVENTIONS/TEACHING
Deep breathing exercises can improve or
maintain lung capacity.
Swimming as part of your exercise
program helps to maintain chest expansion
and movement of the spine without jarring
the spine. Breast stroke is especially good
for chest expansion.
You should avoid contact sports, since joint
fusion may make your spine more likely to
fracture as the disease progresses, but
your doctor may approve of other activities
such as golf and tennis.
INTERVENTIONS/TEACHING
Maintaining proper posture and chest
expansion. Good posture is important
because it can help prevent abnormal
bending of the spine . Maintaining chest
expansion will help prevent problems such
as lung infection (pneumonia). It's a good
idea to lie on your stomach a few times
each day to keep your spine and hips
extended. For sleeping, choose a firm
mattress and a small pillow that supports
your neck.
INTERVENTIONS/TEACHING
Using assistive devices such as canes or
walkers. Your local chapter of the Arthritis
Foundation, your physical therapist, or a
medical supply company may be able to
help you find assistive devices in your
area. If your neck is becoming stiff, your
doctor may recommend that you wear a
soft neck brace when you ride in the car, to
prevent injury in case of an accident .
INTERVENTIONS/TEACHING
AVOID SMOKING
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