Ankylosing Spondylitis Treatment Guidelines

Ankylosing spondylitis (AS) is a chronic, painful and potentially crippling inflammatory disease that begins in the sacroiliac, apophyseal, and costovertebral joints and gradually progresses to the lumbar, thoracic, and cervical regions of the spine. More often diagnosed in young men, AS may be misdiagnosed in women, making the disease equally prevalent in both sexes.

• AS gradually progresses to the spine.

Causes

• Causes of AS include familial history and immunologic activity. According to the Research Institute of Scripps Clinic, Department of Immunology, California, and the Division of Rheumatology, Department of Medicine, University of California-Los Angeles Center for Health Sciences, the presence of histocompatibility antigen HLA-B27 appears in over 90 percent of Caucasian AS patients, compared to just 7 percent of the general population. The study indicates that genes linked to HLA- B27 encode for an immune response that may lead to the disease. Additionally, the antigen may also contribute to tissue damage.

Signs and Symptoms

• The initial sign of the condition is intermittent lower back pain, usually upon waking up in the morning. Additional symptoms depend upon the stage of the disease and many include stiffness and limited motion of the lumbar spine, chest pain, shoulder, hip, and knee arthritis, hip deformity, tenderness at inflammation site, fatigue, fever, loss of weight and aortic regurgitation.

  Symptoms can progress dramatically; conversely, the disease can suddenly go into remission.

Drug Therapy

• Little in the way of treatment reliably cures or stops the progression of AS. Recent medications, however, may control symptoms. Physicians initially prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and stiffness.

  If these provide little comfort, the perscription may include a second-string of anti-rheumatic medications such as Sulfasalazine, Methotrexate and Corticosteroids.

  Biologic drugs, or TNF blockers, are the latest drug therapy for AS. Enbrel, Remicade and Humira may be beneficial in the treatment of both arthritis of the joints and spinal arthritis.

Other Treatments

• Other symptom control tools include: good posture, stretching and breathing exercises, aspirin, massage, weight control, and the application of heat to stiff joints and cold to inflamed regions.

Warning

• Severe hip and knee deformities may require surgical replacements. More risky with a long convalescence and chance of spinal cord damage, severe spinal deformity may necessitate spinal surgery to separate and reposition vertebrae.