A Family Doctor's Tale - ANKYLOSING SPONDYLOSIS

DOC I HAVE A PAINFUL STIFF BACK

Ankylosing spondylosis is not a common illness.  In my 37 years of practice, I have only seen 2 cases of ankylosing spondylosis. 
Both are male and in their late twenties. 
They presents with severe pain and stiffness of the back. 
Confirmation of the disease is by X-rays of the spine and sacrum.
It is related to auto-immune diseases like rheumatoid arthritis and psoriasis. Like all auto immune disease the condition cannot be cured but can be controlled with medicines and exercise.

Ankylosing Spondylosis is a chronic inflammatory disease of the joints of the spine, manifested by fusion(ankylosing) and inflammation(spondylosis) of some or all of the joints and bones of the spine. 
It is a painful progressive disease affecting mainly the spine. 
It can also affect other joints, tendons, ligaments, also other areas such as eyes,lungs,bowels and heart.


Every one can get Ankylosing Spondylosis.
The age of onset is usually in the late teens or early 20's.
It is also more common in men than women about 5:1.

In men the spine and pelvis are most affected.
In women the pelvis,hips,knees,wrists and ankles are more common.


Inflammation occurs at the attachment of the ligaments and tendons to the bone.
Erosion of the bones occur at the site.
When the inflammation subside, new bone develop and replaces the elastic tissues of the ligaments or tendons.
Fusion of bones occur leading to restriction of movement.
This usually starts in the vertebra of the spine followed by the pelvis, then upwards to the chest wall and neck.


The onset is usually gradual with occasional back pain over weeks or months.
Early morning stiffness and pain occurs,then wears off during the day.
It gradually becomes affecting the lower back first then upwards to to the neck, resulting in stiffening of the back.
Chest expansion can become limited because of the the stiffness of the bones.
Sometimes peripheral joints such as shoulders and hips are affected.
Weight loss and fatigue may occur in the early stages.
ESR is raised in most cases. RA factor is not present.


It can sometimes affect the eyes, heart and lungs. These effects are not life-threatening and they can be treated with relative ease. Inflammation of the iris of the eye(Uveitis) occur in 5% of cases with blurring of vision
Occasionally it may affect the heart causing the aortic valve to leak.
The rib joints and muscles are also affected resulting tightness of the chest making breathing painful.


Confirmation is usually by an x-ray of the spine and pelvis.
 
Not every patient suffer the same degree of symptoms
Some may be very mild requiring only exercises or mild pain killers.
Others may be more severe requiring strong NSAIDS or RA drugs such as sulphasalazine
ANTI-TNF drugs has found to help improve the RA patients and also AS patients.


Symptoms comes and go. 
With exercise and NSAIDS pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture. 

Ankylosing Spondylosis is never life threatening and can be controlled but not cured.