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Home » Health Articles » My Doctor Has Diagnosed Me With Ankylosing Spondylitis I Want To Know More About It

My Doctor Has Diagnosed Me With Ankylosing Spondylitis... I Want To Know More About It...

Ankylosing spondylitis (AS) is a chronic, systemic, inflammatory form of arthritis that preferentially affects the spine leading to limitation of spine movement. The cause of AS is not fully known, but there is a strong genetic predisposition associated with a genetic marker called the human leukocyte antigen (HLA)-B27.

AS usually begins with back pain and stiffness in the late teen years and early adulthood due to inflammation of the sacroiliac joints (the joints that join the spine to the pelvis) and the spine. AS also has a tendency for affecting sites where ligaments attach to bone. When inflammation affects these areas, the condition is called "enthesitis."

The most common joints outside of the spine and sacroiliac joints to be affected are the hip and shoulder joints. Other joints such as the knee, wrist, ankle, and elbow can also be involved. Some patients may develop eye inflammation termed "acute anterior uveitis".

Involvement of the heart and lungs, while rare, can be a complication. There may also be an association with psoriasis or inflammatory bowel disease.

Males are affected twice as often as females. Onset of symptoms after age 45 is unusual. Roughly, 15% of patients have disease onset during childhood.

The earliest symptom can be a dull pain in the buttock region. This occurs as a result of sacroiliac joint involvement. Some patients may have radiation of pain down the upper part of the back of the thigh and be misdiagnosed as having sciatica.

The pain at first may be one-sided and intermittent. It may also alternate, first in one buttock and then the other, but the pain, over time, becomes persistent and involves both sides.

The low back area becomes stiff and painful. This may be accompanied by tenderness along the spine and in the sacroiliac joints.

The back symptoms tend to worsen after prolonged periods of rest so that a patient will say their worst times are late at night and early in the morning. The symptoms improve with physical activity or exercise and worsen with rest.

The back symptoms also worsen with exposure to cold or dampness. Some patients have fleeting aches and pains or tender spots that can lead to a misdiagnosis early on of fibromyalgia.

Sometimes, the first symptom can be pain and stiffness in the middle part of the spine (thoracic region) or even the neck. Sometimes chest pain may be more of a symptom than low back pain.

Eye inflammation in the form of anterior uveitis is the most common non-joint feature of AS. This complication occurs in 25%-40% of patients at some time during their disease.

Clinical examination may or may not be helpful in the early course of the disease. The physician should examine the sacroiliac joints and the entire spine, including the neck. Chest expansion (the ability to move the chest with a deep breath) along with range of motion of the hip and shoulder joints should be measured. A search for signs of enthesitis can be helpful in making an early diagnosis of AS. The areas to search for enthesitis include the spinous ligaments, pelvis, front chest wall, bottom of the heels, back of the heels (Achilles tendon), outside of the hips, and the front of the knees just below the kneecap. This area is called the tibial tubercle.

The muscles along the spine may also be tender.

As the disease progresses, the spine becomes stiffer leading to loss of mobility in all directions. Chest movement also becomes more restricted.

Spinal deformities slowly progress and make the spine more rigid. Some patients may develop osteoporosis. If osteoporosis accompanies the rigidity, then a particularly dangerous situation develops because this rigid osteoporotic spine is very susceptible to fracture even after minor trauma.

The diagnosis of AS is based on physical exam and confirmed by imaging procedures. Symptoms, family history, and the joint exam are the most important tools early on.

X-ray evidence of AS may not be evident early in the course of the disease. Patients may need to undergo magnetic resonance imaging (MRI). MRI can detect subtle inflammatory changes in the sacroiliac joints and other areas of enthesitis early on HLA-B27 typing can be helpful in cases where AS is suspected but the diagnosis remains uncertain.

In cases where AS suspected, the HLA-B27 test may allow the presumptive diagnosis of AS to be made.

However, the presence of HLA-B27 should not be used to diagnose AS in the absence of other supporting history and physical exam evidence.

Dr. Muhammad Khan, the world's foremost expert in AS, has flatly stated that, "HLA-B27 testing is inappropriate in patients with back pain or arthritis in whom neither the history nor the physical examination suggests the presence of AS. A positive result in this clinical situation would still not permit the diagnosis of AS to be made because up to 8% of the general population possesses this gene."

Laboratory tests measuring inflammation are of limited value. Elevation of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) occurs in about 70% of patients with active AS. The problem is that there is not a good correlation between the elevation in these blood tests and disease activity.

It may be that the increases in ESR and CRP reflect the presence of active arthritis in joints outside of the spine. Normal ESR or CRP does not exclude the presence of clinically active AS.

Successful treatment of AS requires a combination of non-drug as well as appropriate drug therapies.

Patient education is important and should include a life-long program of regular stretching and range-of-motion exercise. Smokers should be encouraged to stop smoking.

Use of non-steroidal anti-inflammatory drugs (NSAIDs) is often helpful. Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide (Arava), and sulfasalazine (Azulfidine), are not useful for the treatment of disease restricted to the spine. They may be helpful in patients where peripheral joint arthritis or enthesitis is present.

Tumor necrosis factor (TNF) inhibiting agents, etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) are very effective in treating AS patients.

MRI studies have shown that TNF-inhibitors are capable of resolving severe inflammation in the spine as well as in peripheral joints. Whether these drugs can prevent structural damage remains to be seen.

As with all forms of arthritis that require immunosuppressive therapy, close supervision of the patient is mandatory.

Surgery may be required for cases of AS that don't respond to medical therapy. Joint replacement, in the case of peripheral involvement, and corrective spinal surgery may be needed.

Fortunately, today, quicker diagnosis and more aggressive medical intervention have reduced the need for surgical solutions.

One other note of caution... In patients with significant neck involvement and rigidity, intubation for general anesthesia is extremely difficult and dangerous. These patients should notify the anesthesiologist in cases of elective surgery. They should also wear an ID bracelet advising of their condition.

And here is another random article you might be interested in...

Five Tips for Turning Your Web site into a Lead Generator

Remember the days when it seemed as if every Web site began with a home page that featured some sort of animated flash, with the "skip intro" link as a way out? With all due respect to some highly creative interactive Web designers, today's Web sites need to be highly focused, content-rich, and finely-tuned in order to achieve maximum impact, visibility, and usability. In my own experience working with our clients at Nowspeed Marketing, we have found that most companies can take their existing corporate Web site and optimize it for effective lead generation.

Below are five best-practice tips you can use to help turn your Web site in to a lean, mean, lead generation machine.

Tip #1: See your Web site through the eyes of the visitor

Visitors to your Web site want to understand immediately who you are, what you do, and, most of all, what you can do for them. They want clear, logical paths for navigating through the site to get more information. This means you must design content and offers that speak directly to different target audiences, in terms of their demographics and job functions, and that also ork well across the buying cycle ("tryers" vs. "buyers".) Start with your home page, but don't stop there. Make your interior pages content-rich and offer-specific as well.

Tip #2: Keep it clean, clear and concise

A common mistake is to put so much information and so many links on the home page or interior pages, that they quickly become cluttered. Think of the page in terms of valuable, limited real estate. Utilize it wisely. For the home page, Include an SEO-optimized description of who you are and what you do. Provide short blocks of text and clear click-through paths for different types of visitors (customers/prospects/info seekers). Place high-performing, relevant offers where the eye can see them without much effort. Whenever you can, avoid making the user scroll down the page.

Tip #3: Balance search with simplicity

Optimizing your site for organic search is critical. Jupiter Research estimates that organic indexes generate 87% of commercial referrals from search engines. However, you need to weigh the benefits of high keyword placement with simplicity and usability from the visitor's perspective. Don't go SEO-overboard. Our advice is to SEO-optimize your copy and tags around keywords that have the following characteristics: high traffic, low competition, and are a good fit with your business. For example, the keyword phrase "B2b lead generation agency" works better for our marketing agency than "interactive agency." Keep copy targeted around these parameters, and you will not only connect well with your audience, but your will also rank high in organic search.

Tip #4: Evaluate traffic patterns for best offer and content placement

Use a Web analytics tool to see where people are clicking through from your home page, and which interior pages are receiving the most click-throughs and/or longest retention. Then, place your best offers there. You may be surprised to find that what you think is important, such company news links on the home page, is in reality a low traffic area. If that is the case, consider replacing that link with one to a page that is more relevant. Or, if your "About Us" page is getting a lot of traffic, place more links and offers on that page to encourage them to explore other areas of your site and request information.

Tip #5. Test, update, and fine-tune

Once you've got a solid, lead-based architecture in place, monitor visitor behavior and fine-tune various elements of the site until it is performing at the highest possible level of effectiveness. Utilize Web analytics to perform offer and message testing. Remember that, like content, offers can become outdated fairly quickly. As their popularity begins to wane, refresh your site with new offers.