Ankylosing Spondylitis

Definition

Ankylosing spondylitis (AS) refers to inflammation of the joints in the spine. AS is also known as rheumatoid spondylitis or Marie-Strümpell disease (among other names).

Description

A form of arthritis, AS is characterized by chronic inflammation, causing pain and stiffness of the back, progressing to the chest and neck. Eventually, the whole back may become curved and inflexible if the bones fuse (this is known as "bamboo spine"). AS is a systemic disorder that may involve multiple organs, such as the:

eye (causing an inflammation of the iris, or iritis)
heart (causing aortic valve disease)
lungs
skin (causing a scaly skin condition, or psoriasis)
gastrointestinal tract (causing inflammation within the small intestine, called ileitis, or inflammation of the large intestine, called colitis)

Less than 1% of the population has AS; however, 20% of AS sufferers have a relative with the disorder.

Causes and symptoms

Genetics play an important role in the disease, but the cause of AS is still unknown. More than 90% of patients have a gene called HLA-B27, but only 10-15% of those who inherit the gene develop the disease. Symptoms of AS include:

low back and hip pain and stiffness
difficulty expanding the chest
pain in the neck, shoulders, knees, and ankles
low-grade fever
fatigue
weight loss

AS is seen most commonly in males 30 years old and older. Initial symptoms are uncommon after the age of 30, although the diagnosis may not be established until after that age. The incidence of AS in Afro-Americans is about 25% of the incidence in Caucasians.

Diagnosis

Doctors usually diagnose the disease simply by the patient's report of pain and stiffness. Doctors also review spinal and pelvic x rays since involvement of the hip and pelvic joints is common and may be the first abnormality seen on the x ray. The doctor may also order a blood test to determine the presence of HLA-B27 antigen. When a diagnosis is made, patients may be referred to a rheumatologist, a doctor who specializes in treating arthritis. Patients may also be referred to an orthopedic surgeon, a doctor who can surgically correct joint or bone disorders.

Treatment

Physical therapists prescribe exercises to prevent a stooped posture and breathing problems when the spine starts to fuse and ribs are affected. Back braces may be used to prevent continued deformity of the spine and ribs. Only in severe cases of deformity is surgery performed to straighten and realign the spine, or to replace knee, shoulder, or hip joints.

Alternative treatment

To reduce inflammation various herbal remedies, including white willow (Salix alba), yarrow (Achillea millefolium), and lobelia (Lobelia inflata), may be helpful. Acupuncture, performed by a trained professional, has helped some patients manage their pain. Homeopathic practitioners may prescribe such remedies as Bryonia and Rhus toxicodendron for pain relief.

Prognosis

There is no cure for AS, and the course of the disease is unpredictable. Generally, AS progresses for about 10 years and then its progression levels off. Most patients can lead normal lives with treatment to control symptoms.

Prevention

There is no known way to prevent AS.

Key terms

Ankylosing — When bones of a joint are fused, stiff, or rigid.

HLA-B27 — An antigen or protein marker on cells that may indicate ankylosing spondylitis.

Immune suppressing — Anything that reduces the activity of the immune system.

Inflammation — A reaction of tissues to disease or injury, often associated with pain and swelling.

Spondylitis — An inflammation of the spine.

Resources

Organizations

Arthritis Foundation.1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. http://www.arthritis.org.

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse. 1 AMS Circle, Bethesda, MD 29892-3675. (301) 495-4484.

Spondylitis Association of America. P.O. Box 5872, Sherman Oaks, CA 91413. (800) 777-8189.

Other

Matsen III, Frederick, ed. "Ankylosing Spondylitis." University of Washington Orthopaedics and Sports Medicine. http://www.orthop.washington.edu/arthritis/types/ankylosingspondylitis.

spondylitis

[spon″dĭ-li´tis]

inflammation of the vertebrae, usually a serious and chronic disorder. It may be associated with tuberculosis of the bones, in which case it is called pott's disease. The vertebrae become eroded and collapse, causing kyphosis. Spondylitis may also be associated with other infectious diseases, such as brucellosis, in which the intervertebral disks and the vertebrae are affected and sometimes destroyed; this is one cause of ankylosing spondylitis, a particularly serious variety.

ankylosing spondylitis (Bekhterev's spondylitis) a form of rheumatoid arthritis that affects the spine, characterized by inflammation of the facet joints and inflammatory changes of the stabilizing ligaments of the spine (enthesopathy). It affects males almost exclusively. There is stiffening of spinal joints and ligaments, so that movement becomes increasingly painful and difficult. When it runs its full course, it results in bony ankylosis of the vertebral joints, which may extend to the ribs and limit the flexibility of the rib cage, so that breathing is impaired. Called also Marie-Strümpell disease or spondylitis and rheumatoid spondylitis.

Typical posture of patient with ankylosing spondylitis. From Copstead and Banasik, 2000.

Kümmell's spondylitis Kümmell's disease.

Marie-Strümpell spondylitis ankylosing spondylitis.

post-traumatic spondylitis Kümmell's disease.

rheumatoid spondylitis ankylosing spondylitis.

an·ky·los·ing spon·dy·li·tis

[MIM*106300]

arthritis of the spine, resembling rheumatoid arthritis, which may progress to bony ankylosis with ossification of the anterior and posterior longitudinal ligaments; the disease is more common in males, often with the rheumatoid factor absent and the HLA antigen present. There is a striking association with the B27 tissue type and the strong familial aggregation suggests an important genetic factor, perhaps inherited as an autosomal dominant [MIM*106300]; the mechanism, however, remains obscure.

Synonym(s): Marie-Strümpell disease, rheumatoid spondylitis, Strümpell-Marie disease

Farlex Partner Medical Dictionary © Farlex 2012

ankylosing spondylitis

(ăng′kə-lō′sĭng, -lō′zĭng)

A chronic form of arthritis that chiefly affects the spine and can lead to fusion of the vertebrae.

ankylosing spondylitis

Rheumatology A polyarthritis of the vertebral column, which is characterized by progressive, painful stiffening of the joints and ligaments, which primarily affects young ♂ Risk factors AS is linked to HLA B27; individuals with B27 have a 300-fold ↑ risk for AS Clinical ↓ ROM of back, ↓ chest expansion; transient–50% or permanent peripheral arthritis; uveitis in 25% Imaging Diagnostic changes in sacroiliac joints Laboratory ↑ ESR, normal ANAs, rheumatoid factors; 90% of AS Pts have HLA B27 Management NSAIDs, physical therapy

an·ky·los·ing spon·dy·li·tis

(ang'ki-lōs-ing spon'di-lī'tis)

Arthritis of the spine, resembling rheumatoid arthritis, which may progress to bony ankylosis with lipping of vertebral margins; the disease is more common in the male, often with the rheumatoid factor absent and the HLA antigen present. There is a striking association with the B27 tissue type and the strong familial aggregation suggests an important genetic factor.
Synonym(s): rheumatoid spondylitis.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

ankylosing spondylitis

A chronic inflammatory disease of the spinal column leading to stiffening and fixity of the ligaments and bones, so that, eventually, almost all movement is lost.

ankylosing spondylitis

a type of arthritis known to be associated with the HLA antigen B₂₇. Although this antigen occurs in only 8% of the British population, 90% of British patients with the condition have B₂₇. However, the fact that not all affected people possess the antigen and, conversely, not all people with B₂₇ have the condition, indicates that B₂₇ cannot be the cause of ankylosing spondylitis. It may be that the antigen increases susceptibility to an environmental agent such as a virus.

Strümpell,

Ernst Adolf von, German physician, 1853-1925.

Fleischer-Strümpell ring - Synonym(s): Kayser-Fleischer ring

Marie-Strümpell disease - Synonym(s): Strümpell-Marie disease

Strümpell disease - arthritis and osteitis deformans involving the spinal column. Synonym(s): acute epidemic leukoencephalitis; spondylitis deformans

Strümpell-Marie disease - arthritis of the spine, resembling rheumatoid arthritis, that may progress to bony ankylosis. Synonym(s): ankylosing spondylitis; Marie-Strümpell disease

Strümpell phenomenon - dorsal flexion of the great toe in a paralyzed limb when the limb is drawn up against the body, flexing knee and hip. Synonym(s): tibial phenomenon

Strümpell reflex - stroking the abdomen or thigh causes flexion of the leg and adduction of the foot.

Strümpell-Westphal disease - Synonym(s): Wilson disease

Westphal-Strümpell pseudosclerosis - Synonym(s): Wilson disease

iridocyclitis

Inflammation of both iris and ciliary body. The ciliary body is almost always involved with an inflammation of the iris. The clinical picture of iridocyclitis is practically the same as iritis. The condition is often associated with ankylosing spondylitis or sarcoidosis. See anisocoria; rheumatoid arthritis; heterochromia; Behçet's syndrome; uveitis.

uveitis

Inflammation of the uvea. All three tissues of the uvea tend to be involved to some extent in the same inflammatory process because of their common blood supply. However, the most severe reaction may affect one tissue more than the others as in iritis, cyclitis or choroiditis or sometimes two tissues, e.g. iridocyclitis. The symptoms also vary depending upon which part of the tract is affected. Acute anterior uveitis is accompanied by pain, photophobia and lacrimation and some loss of vision because of exudation of cells (aqueous flare), protein-rich fluid and fibrin into either the anterior chamber or vitreous body, as well as ciliary injection, adhesion between the iris and lens (posterior synechia), miosis and keratic precipitates. The condition is often associated with ankylosing spondylitis, rheumatoid arthritis, sarcoidosis, syphilis or tuberculosis (usually with granulomatous uveitis). It is the most common form of uveitis. Many cases are HLA-B27 positive. Treatment includes corticosteroids and mydriatics to reduce the risk of posterior synechia and to relieve a spasm of the ciliary muscle. See juvenile idiopathic arthritis; Reiter's disease; Busacca's nodules; Koeppe's nodules; sympathetic ophthalmia; Behçet's syndrome; phthisis bulbi; synchisis scintillans; Vogt-Koyanagi-Harada syndrome; Table I6.
fungal uveitis Uveitis caused by a fungus such as Candida albicans, Cryptococcus neoformans and Histoplasma capsulatum. It is often accompanied by other disorders (e.g. choroiditis, retinitis). It may have spread from other bodily tissues (e.g. skin, mouth, gastrointestinal tract) in patients who are intravenous drug addicts, patients with indwelling venous catheters or patients who are immunosuppressed.
intermediate uveitis A chronic inflammation of the ciliary body (cyclitis) or its pars plana zone (pars planitis) or of the peripheral retina and vitreous (peripheral uveitis). The cause is unknown in most cases but others are associated with systemic conditions such as multiple sclerosis, sarcoidosis or HIV infection. It affects mainly young adults and is bilateral in about 80% of cases. Symptoms are floaters and, sometimes, blurred vision, and there may be anterior chamber cells and flare. Ophthalmoscopic examination may show vitreous condensation and gelatinous exudates ('cotton balls' or 'snowballs'). Snowbanking, i.e. a whitish plaque or exudates involving the pars plana, often the inferior part of it, appears mainly in pars planitis. Intermediate uveitis may be associated with retinal vasculitis (i.e. inflammation of a retinal blood vessel). In a few cases the condition is self-limiting within a few months. However, in most cases the condition lasts several years may lead to complications such as cystoid macular oedema, posterior subcapsular cataract, retinal detachment or cyclitic membrane formation. Treatment includes corticosteroids and in resistant cases immunosuppressive agents.
posterior uveitis A uveitis involving the posterior segment of the eye. Symptoms include floaters and visual loss if the choroiditis involves the macular area. Ophthalmoscopically there is an accumulation of debris in the vitreous and choroidal lesions appear as yellow-white areas of infiltrates surrounded by normal fundus. Retinitis is also present in most cases, as well as retinal vasculitis. Posterior uveitis may be associated with AIDS, Behçet's disease, Lyme disease, histoplasmosis, sarcoidosis, toxoplasmosis, syphilis, tuberculosis, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, etc.
viral uveitis Uveitis caused by a virus. Common viruses are: herpes simplex, which is usually associated with keratitis and may cause anterior uveitis; herpes zoster which may also be associated with keratitis; human T-cell lymphotrophic virus; measles; cytomegalovirus; rubella; human immunodeficiency virus (HIV). See herpes simplex blepharoconjunctivitis; herpes zoster ophthalmicus.

Patient discussion about ankylosing spondylitis

Q. Is ankylosing spondylitis genetically inherited?

A. It is known today that ankylosing spondylitis (spondyloarthritis) has a very strong genetic connection. It is not a disease inhertited by a single gene that is dominant, but certainly there is genetic predisposition in families (and a more detailed information- about 90% of the patients express the HLA-B27 genotype).

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