Ankylosing spondylitis

 ICD9           = 720.0|
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 OMIM           = 106300 |
 MedlinePlus    = 000420 |
 eMedicineSubj  = radio |
 eMedicineTopic = 41|
 DiseasesDB     = 728 |

}} Ankylosing spondylitis (AS) is a chronic, progressive inflammatory arthritisprimarily affecting spineand sacroiliac joints, causing eventual fusion of the spine; it is a member of the group of the spondylarthropathies. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.

Treatment is with physiotherapyand medication. Some cases remain mild, while other result in marked disability.

Signs and symptoms

The typical patient is a young man of 15-30 years old (although women are also affected) with pain and stiffness in the spine. It is also associated with iridocyclitis(anterior uveitis), ulcerative colitis, psoriasisand Reiter's disease, through HLA-B27 (see below).

Osteopeniaor osteoporosisof AP spine, causing eventual compression fractures and a back "hump" if untreated.

Organs affected by AS, other than the axial spine, are the hips, heart, lungs, heels, and other areas (peripheral).

Ankylosing spondylitis affects the eyes in up to 40 percent of cases, leading to episodes of eye inflammation called acute iritis. Acute iritis causes eye pain and increased sensitivity to light (photophobia).

Diagnosis

The diagnosis is by X-raystudies of the spine, which show characteristic spinal changes and sacroiliitis. A normal X-ray does not exclude the disease.

Variations of the HLA-B gene increase the risk of developing ankylosing spondylitis, those with the HLA-B27 variant are at highest risk of developing the disorder. HLA-B27, demonstrated in a blood test, is occasionally used as a diagnostic, but does not distinguish AS from other diseases and is therefore not of real diagnostic value. Effective Diagnosis can also happen via MRI scans. Unattended cases normally lead to knee pain, resulting in a fair assumption of normal rheumatism.

Pathophysiology

AS is a systemic rheumaticdisease, and about 90% of the patients are HLA-B27positive. HLA-DRand IL1raare also implicated in ankylosing spondylitis. Although specific autoantibodies cannot be detected, its response to immunosuppresive medication has prompted its classification as an autoimmune disease.

Hypotheses on its pathogenesis include a cross-reaction with antigens of the Klebsiella bacterial strain (Tiwana et al. 2001). Particular authorities argue that elimination of the prime nutrients of Klebsiella (starches) would decrease antigenemia and improve the musculoskeletal symptoms. On the other hand, Khan (2002) argues that the evidence for a correlation between Klebsiella and AS is circumstantial so far, and that the efficacy of low-starch diets has not yet been scientifically evaluated. Similarly, Toivanen (1999) found no support for the role of kebsiella in the etiology of primary AS.

Epidemiology

The sex ratio is 3:1 for men:women. In the USA, the prevalenceis 0.25%, but as it is a chronic condition, the number of new cases (incidence) is fairly low.

Therapy

Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosing spondylitis.

Physical therapy

• Stretching- yoga, pilates
• Exercise- swimming, jogging, etc.

Medication

There are four major types of medications used to treat ankylosing spondylitis:

• NSAIDssuch as aspirin, ibuprofen, naproxenand COX-2 inhibitors, which reduce inflammation and pain;
• Steroids;
• DMARDssuch as methotrexateand sulfasalazine, which are immunosuppressants; and
• TNFαreceptors such as etanerceptand infliximab, also known as biologics.

Alternative medicine

• Diet- starch free diet (Ebringer et al 1996), london diet, Paleolithic diet

Prognosis

AS can range from mild to progressively debilitating, and from medically controlled to refractive.

Famous patients

Well known sufferers of AS include Mötley Crüeguitarist Mick Mars, the former England cricketcaptain Mike Atherton, former Australian cricketer Michael Slaterand Toronto, Ontario radio personality Mike Stafford as well as Norwegian Prime Minister Jens Stoltenbergand the chess player Vladimir Kramnik. ^{[citation needed]}

See also

• NASC, the AS patients' federation
• NIAMS, the National Institute of Arthritis and Musculoskeletal and Skin Diseases

Reference

• Ebringer A, Wilson C. The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis. Clinical Rheumatology 1996 Jan;15 Suppl 1:62-66. PMID 8835506.
• Khan MA. 2002. Ankylosing spondylitis: The facts. Oxford University Press. ISBN 0192632825.
• Tiwana H, Natt RS, Benitez-Brito R, Shah S, Wilson C, Bridger S, Harbord M, Sarner M, Ebringer A. Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis. Rheumatology (Oxford) 2001;40:15-23. PMID 11157137.
• Toivanen, Paavo, et al. "Somatic Serogroups, Capsular Types, and Species of Fecal Klebsiella in Patients with Ankylosing Spondylitis" Journal of Clinical Microbiology, September 1999, p. 2808-2812, Vol. 37, No. 9.

External links

National organizations

• National Ankylosing Spondylitis Society(UK)
• Spondylitis Association of America(USA)

Support groups

• KickAS.org(online community; support and information)cs:Becht?revova nemoc

de:Morbus Bechterew fr:Spondylarthrite ankylosante nl:Ziekte van Bechterew no:Bekhterevs sykdom pl:Zesztywniaj?ce zapalenie stawów kr?gos?upa

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Ankylosing+spondylitis Wikipedia article Ankylosing spondylitis.