ANKYLOSING SPONDYLITIS

General Information

DEFINITION--A chronic, progressive, rheumatic disease of the joints, accompanied by inflammation and stiffening. It is characterized by a "bent forward" posture caused by stiffening of the spine and support structures.

BODY PARTS INVOLVED--Sacroiliac region; hip joints; lumbar, thoracic and cervical spines.

SEX OR AGE MOST AFFECTED--Within families, males and females are affected equally. In the general population, males are affected 4-5 times more frequently than females, and onset is usually late teens or early twenties.

SIGNS & SYMPTOMS

Early stages:

• Recurrent episodes of low backache. Pain can also occur along the sciatic nerve.
• Stiffness that is worse in the morning.

Later stages:

• Progressive worsening of symptoms. Pain often spreads from the low back to the middle back or higher in the neck. Joints in the arms, legs, feet and hands are sometimes affected.
• Anemia; muscle stiffness; fatigue; weight loss; iritis (in about 25% of patients).

CAUSES--Unknown, but it may be caused by genetic changes or autoimmune disorder.

RISK INCREASES WITH--Family history of ankylosing spondylitis. Occurs more frequently in North American Indians and in white popula-tion of North America and Western Europe.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies.
• X-rays of the spine.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to replace a damaged hip or to insert bone grafts in the spine (advanced stages only).

POSSIBLE COMPLICATIONS

• Congestive heart failure.
• Eye inflammation, rarely causing blindness.
• Amyloidosis.
• Heart-valve disease.
• Gastrointestinal disease.
• Lung disease.
• Nerve compression causing numbness in arms or legs.
• Permanent disability and immobilization.

PROBABLE OUTCOME--This disease is currently considered incurable. Symptoms progress unpredictably with mild or moderate flares and periods of total remission. With treatment, symptoms can be relieved or controlled and most patients can lead normal, productive lives. Occasionally, the disease is severe and incapacitating due to deformities.

How To Treat

GENERAL MEASURES--

• Therapy includes exercises for breathing techniques, maintaining proper posture and building up muscle groups (to oppose the direction of possible deformities). Patient compliance with therapy is important.
• Psychological counseling may be recommended.
• Sleep on your back on a firm mattress. Use a small pillow or none at all.
• Take hot baths or use heat compresses before exercising or to relieve pain. Have regular massages, if possible.
• Additional information available from the Arthritis Foundation (800)283-7800.

MEDICATION--Your doctor may prescribe:

• Nonsteroidal anti-inflammatory drugs. Don't take narcotics for pain; they are addictive.
• Stronger pain medications and muscle relaxants for short periods of time.
• Sulfasalazine, vitamin D and immunosuppressive therapy.

ACTIVITY--Stay as active as your strength allows:

• Exercise to maintain good posture and retain as much upright carriage as possible. Back braces don't help.
• Swim regularly, if possible. Your buoyancy in water will allow you to move stiff, painful areas more easily.
• Avoid activity that puts stress on the back and avoid contact sports (too much risk of spinal injury).

DIET--No special diet.

Call Your Doctor If

• You or your child have symptoms of ankylosing spondylitis.
• The following occurs during treatment: A fever occurs. Increasing pain and disability, despite measures outlined above.