Ankylosing spondylitis

This is a type of arthritis that affects mainly the spine, the sacroiliac joints and hip joints. The cause is still unknown. It usually affects young adults and twice as many men as women.

 

Symptoms:

  • ankylosing spondylitisPain and stiffness of the spine from the lower back to the neck. This occurs more in the morning and after periods of inactivity. The pain usually improves with exercises.
  • Limited range of motion of joints due to fusion of bones at both ends of the joints. This occurs in :
    • spine: leading to inability to straighten or bend the spine normally.
    • hips: thus the patient have difficulty touching his feet and moving the hip joint
    • joints at the ends of the ribs: limiting the patient’s ability to expand the chest sufficiently during taking a deep breath.
  • Pain at areas where the tendons attach to bones e.g. the back of the heel.
  • As this is a systemic disease, the patient may also have fever, loss of appetite, eye problems and fatigue.

 

Diagnosis:

The condition is diagnosed clinically. The diagnosis is confirmed by certain investigations:

  • X-ray of the spine shows a characteristic appearance known as “bamboo spine” due to fusion of the vertebrae together.
  • HLA-B27: Most patients with this disease carry a gene known as HLA-B27. However, 10% of the people carry the same gene without signs of the disease.

 

Treatment:

As the cause of the disease is unknown, there is no definitive cure. Treatment of ankylosing spondylitis aims at decreasing the pain and improving the movement. This is accomplished by:

  • Physiotherapy: to prevent the development of deformities, and improve the function.
  • Exercises: Daily exercises are done to decrease the stiffness and improve the muscle power. This include deep breathing exercises to maintain elasticity of the chest wall.
  • Drugs: non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen help relieve the pain. Disease-modifying antirheumatic drugs (DMARDS) e.g. Humera can be used if NSAIDs are not enough to improve the symptoms.
  • Surgery: Hip replacement surgery is indicated in patients with severe hip arthritis not responding to conservative treatment. Also, spine surgeries may be performed to improve severe spine deformities.

 

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