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Ankylosing spondylitis
Ankylosing Spondylitis (AS) is a chronic, progressive inflammatory
arthritis primarily affecting spine and sacroiliac joints, causing
eventual fusion of the spine. It is characterised as a
spondyloarthropathy (SpA).
Epidemiology
In the USA, the prevalence is 0.25%, but as it is a chronic condition,
the number of new cases (incidence) is fairly low.
The sex ratio is 3:1 for men:women.
Pathophysiology
AS is a systemic rheumatic disease, and about 90% of the patients are
HLA-B27 positive. HLA-DR and IL1ra are also implicated in Ankylosing
Spondylitis.
Signs and symptoms
The typical patient is a young man of 15-30 years old (although women
are also affected) with pain and stiffness in the spine. It is also
associated with iridocyclitis (anterior uveitis), ulcerative colitis,
psoriasis and Reiter's disease, through HLA-B27 (see below).
Organs affected by AS, other than the axial spine, are the hips, heart,
heels, and other areas (peripheral).
Diagnosis
The diagnosis is by X-ray studies of the spine, which show
characteristic spinal changes and sacroiliitis. A normal X-ray does not
exclude the disease.
HLA-B27 is occasionally used, but does not distinguish AS from other
diseases and is therefore not of real diagnostic value.
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Treatment
Physical therapy and exercise, along with medication, are at the heart
of therapy for ankylosating spondylitis.
Medications used are:
Prognosis
AS can range from mild to progressively debilitating, and from medically
controlled to refractive.
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