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Ankylosing Spondylitis is a chronic progressive arthritis condition, mainly affecting the spine. It may affect the peripheral joints and rarely it affects the eyes and heart. Ankylosing means fusing together, Spondylitis means inflammation involving the joints of the spine (Spondylos means vertebrate). The exact cause for Ankylosing Spondylitis is not yet known. Most of the patients who are suffering from this disease carry a genetic cell marker “HLA B27”. It is more common in men, affects 20 – 40 years age group. Usually the disease starts in the Sacroiliac joints, which cause severe low back pain. Most of the non-Rheumatologists interprets it as ‘Mechanical back pain’, disc prolapse or Sciatica. Most people are confused with term Spondylosis, which means wear and tear e.g., Cervical Spondylosis and Lumbar Spondylosis (part of ageing process). The common symptom of Ankylosing Spondylitis is chronic low backache, more than one hour in the morning. It usually starts before the age of 40 years. Typically activity helps and rest deteriorates the low back pain. Some times patient gives a typical history of alternating buttock pain (left or right side) and also down the legs. In Ankylosing Spondylitis the arthritis may affect the other joints too for eg, hips, knees or ankles. The affected joints are painful, swollen, slightly warm and tender to touch. Sometimes patient also has chest wall pain (rib cage) and heels. The routine blood tests would show an elevated erythrocyte sedimentation rate. HLAB27 would be positive in most of the patients. But this is not a must test to establishing the diagnosis of Ankylosing Spondylitis. In the late stages of Ankylosing Spondylitis, the back and spine would be very stiff (bamboo spine). The patient would not be able to bend his spine either forward, backward or side wards. When the neck is affected patient would not be able to bend his neck or turn to the sides. At this stage if the patient wants to see any objects on his side he has to turn the whole body to look at the object.
The most commonly used drugs are NSAIDs. These drugs give good pain relief, comfort and the patient would be able to carry out exercises. When the disease is active Disease Modifying Drugs (DMDs) like Methotrexate, Sulfasalazine, and Azathoiprine will be useful. The most important part of treatment in Ankylosing Spondylitis is exercise, rest would freez joints. Good exercise programs would help to maintain the flexibility of the joints. |
