Posted by: wockhardthospitals | July 23, 2009

Ankylosing Spondylitis:Causes, Symptoms and Treatment

Ankylosing Spondylitis is an inflammatory disease predominantly affecting the spine  causing severe pain, stiffness and loss of movement. In the later stages chronic disease can lead to fusion of the vertebral column resulting in virtual immobility. In addition to the spine, the disease can affect other joints (mainly hips and knee), causing pain, swelling of the affected joints and permanent damage if not adequately treated.

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Age group affected

Ankylosing Spondylitis is approximately three times more common in men than women.

It is generally seen in people in the age group of 20 to 40 years. However it is also known to affect children.

Causes

Ankylosing Spondylitis is believed to be genetically inherited. People with a particular gene called HLA-B27 are at a much higher risk of developing Ankylosing Spondylitis although not everyone with this gene will have the disease. There is no consensus in the medical community as to the other factors that causes the disease; some researchers put it down to a combination of factors i.e. genetics and environment.

Symptoms

The symptoms of Ankylosing Spondylitis are due to inflammation of the spine and joints . Hence pain in the lower / mid back, buttock and neck is usually the initial symptom. Pain is generally worse while resting and more prevalent in the early morning hours resulting in disturbed sleep. It reduces with physical activity and anti-inflammatory pain killers. The onset of pain is generally gradual, progressive with worsening over a period of time and in some cases the progression can be rapid and very disabling.

Patients with severe disease can develop complete fusion of the spine (known as Ankylosis), once fused the pain disappears but spinal mobility is lost resulting in severely compromised quality of life. The disease could affect hips and knees resulting in permanent damage.

Some people with ankylosing spondylitis develop problems other than in the spine viz. eye inflammation (uveitis), skin rashes (psoriais) and chronic diarrhea (inflammatory bowel disease).

The diagnosis of Ankylosing Spondylitis is based on the patient’s symptoms, a physical examination, x-ray findings and blood tests. The changes on X-ray are apparent only in the later stages of the disease. Magnetic resonance scan (MRI) is helpful to diagnose the disease in its early stages and also to delineate the severity.

Treatment

Traditionally the treatment for Ankylosing Spondylitis involved the use of painkillers, physiotherapy and exercise. These only gave partial relief from pain but did not prevent the progression of the disease. Joint replacement surgery is recommended for those with severe hip or knee arthritis.

More recently, over the last few years, newer drugs (Biological therapy / anti-TNF therapy) have been discovered for this disease. The advent of biological therapy has revolutionized care for patients with this disabling disease. Infliximab (Remicade) and Etanercept (Enbrel) are the two drugs that are now available in India. They have been shown to cause dramatic reduction in pain, stiffness and resulting in greatly improved mobility of the spine. They are also believed to prevent the progression of the disease which had not been possible with the older treatments. This would hence reduce the intake of pain killers, reduce deformity and prevent the need for future joint replacement. In order to be more effective they should be used earlier in the disease rather than in the late stages.

What does the doctor say?
It is important to diagnose and treat patients with Ankylosing Spondylitis early so as to enable the patient to lead a relatively normal life. The disease is chronic and hence long-term care is necessary.

More awareness needs to be created among the medical community and the general public to ensure early diagnosis and appropriate treatment.

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