Ankylosing Spondylitis

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Ankylosing Spondylitis

Ankylosing Spondylitis

Ankylosing Spondylitis belongs to a group of chronic inflammatory diseases of the spine called Spondylitis. (It is not the same as rheumatoid arthritis, which is another type of inflammatory arthritis) .Spondylitis means inflammation of the spine. Ankylosis means “fusion”. Spondylitis is also known as Spondyloarthropathy or Spondyloarthritis.

 

Ankylosing Spondylitis is a type of arthritis causing inflammation of the spine. It is most common in teens and young adults although it can also affect children and older people. Ankylosing spondylitis affects about 1 out of every 200 adults.

The inflammation mainly affects the joints between your spine and the joints between the spine and pelvis (sacroiliac joints). However, inflammation may also affect other areas of the body. There are periods of flare-ups and remissions.

Though the exact cause of ankylosing spondylitis remains unknown, genes that increase the chances of a person developing the disease have been identified. Because there is more that one gene involved, the chances of a person passing this disease to his or her children are fairly low.

Ankylosing Spondylitis Diagnosis:

Diagnosis ankylosing spondylitis is often difficult in the early stages or mild cases as back pain is very common and usually caused by muscle strain. An x-ray of the spine and sacroiliac joints is taken. Degenerative changes are usually first seen in the sacroiliac joints. A rheumatologist that specializes in ankylosing spondylitis can usually make an accurate diagnosis.

Ankylosing Spondylitis Symptoms:

The symptoms and severity of ankylosing spondylitis vary - from mild back pain to severe back pain, from mild stiffness to loss of mobility. In the early stages, the the inflammation of the sacroiliac joints cause lower back pain and buttocks pain. Symptoms may come and go.

If inflammation occurs in the middle area of the spine, pain may be felt in the chest area.
Scarring of the tissues and extra bone overgrowth can develop as a result of chronic inflammation. In some severe cases, the ligaments of the spine eventually become fused together by bony overgrowth – this is called ankylosis.

Not all cases of spondylitis reach this stage, but maintaining good posture is essential so that even if the spine does fuse together the spine will be in a fixed upright position rather than a fixed hunched over position.

Remaining active is important. Strengthening and Stretching exercises are helpful. A physical therapist can create a customized exercise program for a patient to follow.

Medications Used to Treat Ankylosing Spondylitis:

Medications for Ankylosing spondylitis are geared at reducing inflammation.

NSAIDs:

Ankylosing Spondylitis is with NSAIDs -nonsteroidal anti-inflammatory drugs. NSAIDs treat the pain and inflammation. Ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, ) and indomethacin (Indocin) are NSAIDs.
When NSAIDs are not effective enough other medications are often used.

Sulfasalazine, often used for inflammatory bowel disease, also can reduce pain and inflammation in the joints and is somtiems used to treat ankylosing spondylitis.

Immunosuppressive agents:

Drugs that suppress the immune system, such as Azathiprine, or Methotrexate are sometimes used to treat Ankylosing spondylitis. Immunosuppressive agents are used to suppress the inflammatory response by suppressing the immune system.

Unlike some inflammatory diseases, ankylosing spondylitis is not considered to be an auto-immune disease (diseases where there are antibodies that attack the bodies own tissues). However, the immune system seems to be overly sensitive in people with ankylosis spondylitis and certain cells of the immune system that initiate inflammation may be triggered too easily.

Corticosteroids (such as prednisone) have extremely powerful anti-inflammatory properties and also suppress the immune system. The problem with corticosteroids is that the side effects are severe in long-term use and the person taking them can develop a host of other unwanted problems.

TNF Inhibitors:

One class of drugs,TNF Inhibitors (such as Remicade), has shown a lot of promise in treating ankylosing spondylitis along with other chronic inflammatory diseases. Remicade suppresses inflammation by binding to and neutralizing substances (TNFa) that act as an alarm signal that triggers inflammation. New drugs in this class are being developed.

Immunosuppressive agents, corticosteroids, and Remicade all increase the risk of infection.

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