Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory arthritis and autoimmune disease which mainly affects the joints in spine, pelvis and sacroiliac joints which leads to fusion of the spine and joints.

Epidemiology

Men are more affected than women. Male female ratio is 3:1. Ankylosing spondylitis has a strong genetic pre-disposition. Onset of the disease is usually at the age of 20 to 40 years.

Signs and symptoms

• Initial symptoms include chronic pain and stiffness in middle part of the spine.
• Pain usually radiates to buttock or back of thigh from sacroiliac joint.
• Inflammation of the eye causing redness, itching, pain, photophobia and loss of vision.
• Fatigue and nausea
• Aortitis, lung fibrosis and ectasia
• Pain and swelling of ankles and feet.
• Pain is severe at rest and improves with physical activity

Development and progression

Ankylosing spondylitis affects the entire body. Specific genotype or antibodies affetcts the CD8 T cells which causes inflammation of the joints and spine. Disease progresses and the symptoms worsens. Eventually fusion of the joints and spine occurs.

Diagnosis

• MRI of sacroiliac joints
• X-ray shows Banboo spine
• CT scan showing Bamboo spine in ankylosing spondylitis
• The Schober's test for clinical measure of flexion of the lumbar
• Blood test may show increase in C-reactive protein and increase in ESR

Treatment

• There is no complete cure for the disease, only supportive treatments are available.
• Exercise and physical therapy are performed along with medications to reduce inflammation and pain. This will help control pain and stiffness.
• Use of supportive aids for walking and performing daily activities may be necessary in advanced stages of the disease.

Medication

• Drugs to relieve pain and inflammation like NSAIDs (Ibuprofen, Diclofenac, Naproxen etc.)
• Drugs to reduce immune system reaction like cyclosporine, methotrexate and corticosteroids
• Rituximab may be used as antibody against CD 20

Surgery

In severe cases, surgery is performed for joint repair or replacement.

Physical therapy

Massages and mild exercise can benefit the patient in reducing inflammation and pain. Physical therapy must be aimed at improving movements of affected joints.

Prognosis

The disease is not curable but with adequate supportive therapies patient can lead a quality life. Surgery can help retain the movements of joints.