Ankylosing spondylitis is a painful, progressive, rheumatic disease mainly of the spine. It has an average disease onset of twenty-three years old and a male/female ratio of 3:1. It very often has a humiliating period of misdiagnosis of approximately eight years, because it is not well understood outside of rheumatology. Once the person has been diagnosed, it is absolutely essential that they receive patient education,which is the reason why The National Ankylosing Spondylitis Society was formed, by rheumatologists and patients, twenty-five years ago.
These are the symptoms that lead the doctor to suspect the condition and, therefore, x-ray the sacroiliac joints:
Slow or gradual onset
Early morning stiffness
Persistence of pain for more than three months
Lessening of pain after exercise, worse with rest
Weight-loss, fatigue and feeling feverish
The condition usually starts at the base of the spine in the sacroiliac joints and has a tendency to work upwards. The rim of the vertebra can become inflamed and as a result, a minute amount of bone wear takes place. The period after the inflammatory process has died down is followed by bone repair. Repeated episodes can lead to vertebra being joined together by bony bridging. In the worst cases, this can affect the whole spine, including the neck, producing one continuous bone. The patients also adopt a tendency towards a forward stooping posture, which can become permanent, once the bony bridging is complete.
Anti-inflammatory drugs are used to help reduce this painful process. The patients then must carry out a regular exercise programme, specifically designed to keep the spine mobile and retain a good posture. These exercises should be taught by a referral to physiotherapists after diagnosis.
Other joints of the body can also be affected, most commonly the hips, knees and ankles. Nearly 50% of patients will also experience a serious eye condition, uveitis, which must be diagnosed and treated immediately to prevent permanent eye damage. Other conditions can overlap, such as the bowel conditions, Crohn's disease and ulcerative colitis as well as the skin complaint psoriasis.
By Fergus J Rogers
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