Ankylosing Spondylitis

(Marie-Strumpell Disease)

Definition

Ankylosing spondylitis is a chronic inflammatory disease of the attachment points between tendons, ligaments, or capsule and bone. It causes arthritis of the joints, mainly the spine and pelvis (sacroiliac joints). Ankylosing spondylitis can also cause inflammation of the eyes, lungs, or heart valves.In severe cases, new bone may develop between the spinal bones. This can cause some areas of the spine to fuse. This fusion will decrease the flexibility and movement of the spine.
Ankylosing Spondylitis
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Causes

The cause of ankylosing spondylitis is not known. Some cases may be associated with a problem in a specific gene.

Risk Factors

Factors that may increase your chance of ankylosing spondylitis include:

Symptoms

The severity of symptoms can vary from mild to very severe.Common symptoms may include:
  • Stiffening and pain (arthritis) of the:
    • Lower back
    • Sacroiliac joint, where the back and hip meet, possibly radiating down the legs
  • Pain that is often worse at night
  • Stiffness that is worse in the morning
  • Symptom improvement with exercise or activity
  • Occasionally, pain and stiffness in other joints:
    • Knee
    • Upper back
    • Rib cage
    • Neck
    • Shoulders
    • Feet
  • Chest pain, which may suggest heart, heart valve, or lung problems
  • Eye pain, visual changes, increased tearing
Less common symptoms may include:
  • Fatigue
  • Loss of appetite or weight loss
  • Fever
  • Numbness (if arthritic spurs compress the spinal nerves)
  • Blood in the urine or swelling from kidney disease
  • Irregular heart beat

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis is based on common symptoms of ankylosing spondylitis, such as:
  • Dramatic loss of motion of the lower back and spine
  • Pain in the lower back
  • Limited chest expansion when taking deep breaths
Blood tests may be done to check for:
  • HLA-B27 gene marker
  • Abnormalities in the blood
  • Signs of autoimmune disease
Images of involved joints may be taken with:

Treatment

There is no cure for ankylosing spondylitis. Treatment is aimed at providing education and relieving the symptoms.Treatments may include:

Medications

Medication may help to control pain and inflammation. They may include:
  • Over-the-counter medication such as nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Prescription medication that suppresses the inflammation such as:
    • Prescription NSAIDs
    • Corticosteroids
    • Disease-modifying antirheumatic drugs (DMARDs)
    • Tumor necrosis factor (TNF)-inhibitors

Physical Therapy

Physical therapy may help prevent progression and worsening of symptoms. Treatment may include:
  • Learning proper posture and the best positions for sleeping
  • Exercise program that includes:
    • Abdominal and back exercises (to decrease back stiffness and maintain good posture)
    • Stretching exercises
    • Water exercises
    • Breathing exercises (in cases where the rib cage is affected)

Surgery

In severe cases, hip or joint replacement surgery may be needed. It will be done to relieve pain and help you move around easier. In some instances, spinal surgery is needed to allow an upright posture.

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Prevention

There are no guidelines for preventing ankylosing spondylitis because the cause is unknown.

RESOURCES

Arthritis Foundation
http://www.arthritis.org

Spondylitis Association of America
http://www.spondylitis.org

CANADIAN RESOURCES

The Arthritis Society
http://www.arthritis.ca

Canadian Spondyloarthritis Association
http://www.spondylitis.ca

References

Ankylosing spondylitis. Spondylitis Association of America website. Available at: http://www.spondylitis.org/about/as.aspx. Accessed December 17, 2014.

Ankylosing spondylitis. University of Washington Orthopedics and Sports Medicine Department website. Available at: http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/ankylosing-spondylitis.html. Accessed December 17, 2014.

Firestein ED et al. Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia: Saunders; 2008.

10/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves new drug to treat psoriasis. US Food and Drug Administration website. Available at:http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183851.htm. Updated April 17, 2013. Accessed December 17, 2014.

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