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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:

  • NSAIDs (anti-inflammatory and pain-reducing)

  • Steroids

  • DMARDs (immunosuppressants)

Prognosis

AS can range from mild to progressively debilitating, and from medically controlled to refractive.

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