Ankylosing Spondylitis

Ankylosing Spondylitis is a chronic inflammatory disease that is known for the pain and progressive stiffness that it causes. This is basically arthritis of the spine and is believed to be hereditary. The gene that they believe is associated with this disease is HLA-B27 and onset will generally occur between the ages of 15-45 years old and effects males about 4 times more then it does women.

What are some of the warning signs

• Frequent lower back pain
• Stiffness in the back that lasts longer then 30 minutes first thing in the morning or after long periods of rest
• Pain and tenderness in the ribs, shoulder blades, hips, thighs, shins, heels and along the bony points of the spine
• In the early stages, there may be mild fever, loss of appetite and general discomfort.
• The eyes can also be affected and symptoms can include eye pain, watery eyes, red eyes, blurred vision, and feeling sensitive to bright light

The most universal symptom is chronic low back pain that seems to just come on for no apparent reason. The pain is typically worse in the morning. On rising from bed, people with AS may feel stiff and sore and this may take anywhere from 30 minutes to several hours to pass off.

The back pain is usually dull and diffuse rather than sharp and localized. The most common site of pain is deep within the buttock, on one side, or on both sides. In addition to the buttock, there could be pain further up the back, perhaps between the shoulder blades or in the neck.

In a lesser number of individuals, pain does not begin in the spine but starts in a hip, knee or shoulder joint. This can be confusing when there is no back pain present and may initially look like some other form of arthritis.

The pain of AS results from inflammation of the joints. When inflammation is present, the involved area hurts. To avoid the pain there is a natural tendency to stoop forward as extending backwards is more uncomfortable. This reflex can lead to bad posture. Also in bed there is a tendency to curl up, as this may feel more comfortable.

Diagnoses
General health and family medical history is important because ankylosing spondylitis can be hereditary. Ankylosing spondylitis may or may not be associated with non-skeletal diseases such as uveitis (eye inflammation), prostatitis (prostate inflammation) and certain disorders affecting cardiac and pulmonary function. A blood workup will reveal the HLA-BA27 antigen. A physical examination often includes the following:

Schober Test: Limited motion in the lumbar spine is symptomatic of AS. The Schober test measures the degree of lumbar forward flexion as the patient bends over as though touching their toes. Progressive loss of spinal motion is correlated with x-ray findings.

Gaenslen Test: Sacroiliac pain is often found in the early stage of AS. Gaenslen's maneuver stresses the sacroiliac joints. Increased pain during this maneuver could be indicative of joint disease.

When AS affects the thoracic spine normal chest expansion may be compromised. The amount of chest expansion is measured from deep expiration to full inspiration. Measurements significantly less than one inch (normal chest expansion) could indicate AS.

General range of motion measures the degree to which a patient can perform movements of flexion, extension, lateral bending, and spinal rotation. Asymmetry may also be noted.

Neurologic Evaluation
A neurologic evaluation is mandatory for patients presenting with a spine disorder. The following symptoms are assessed: pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes.

Radiographic Evidence
Plain radiographs (x-rays) are standard for AS. A CT Scan or MRI may be ordered to evaluate bone and soft tissues (e.g. spinal canal) in greater detail. These tests reveal changes in the spine affected by AS.

For treatment of Ankylosing Spondylitis is basically NSAID's like ibuprofen or aleve. For the pain the doctor may also prescribe a drug called Sulfasalazine which comes from a family of drugs known as disease-modifying anti-rheumatic drugs or they may opt for an injection of cortisone which is a steroid used to help reduce swelling in the joints. Now the injection itself is not designed to relieve pain, the patient may feel relief from the pain as the swelling of the joints is diminished.

From what I understand about this condition is that it can be very painful for the person suffering from it. There are some exercises that a physical therapist would suggest for helping reduce the effects on the joints that are effected by this condition. Like some of the other spinal conditions this one can also effect the Cauda Equina.

For this article I have used several sources which can be found here and here.