SchnitzMD > Knowledge Base > Ankylosing Spondylitis
Ankylosing Spondylitis (AS) is a type of arthritis characterized by inflammation of the spine. It typically occurs in young men. Most patients who have this disease will have had it since the late teen years though it might not be diagnosed until much later. Most people with AS have a gene that probably has to do with causing this disease. It is called HLA-B27. There are other diseases associated with this gene and together these are called spondyloarthropathies. The course of AS is variable but the worst cases get fusion of the spine and arthritis in large joints that causes severe disability. Women sometimes have less spine disease and more peripheral joint arthritis. This makes it harder to diagnose in women and might account for the idea that men get AS more commonly.
One feature that is diagnostic of this disease is SACROILIIITIS or inflammation of the sacroiliac joint. This can be seen on xray of the pelvis though earlier or milder involvement shows up on MRI of the sacroiliac (SI) joints. HLA B27 can be tested and shows up either positive or negative. Other lab tests that are better for following disease activity than diagnosis are called sed rate and c-reacitive protein. They show inflammation.
Patients with AS should stop smoking. This is to preserve lung function in case the chest wall becomes stiff. Next is exercise. Probably any exercise is good to maintain back flexibility but exercises that promote extension of the spine or counter leaning forward might be best. Examples are swimming (esp. snorkelling) or stretching. Medicines range from common anti-inflammatories to help pain and stiffness to newer drugs called biologic agents or TNF inhibitor drugs. These drugs have the potential to stop the disease from getting worse.
The course of someone with AS is hard to predict. Some patients reach old age without signs of any disease while others have severe disability and limtation of movement by middle age.
SPONDY = SPINE
-ITIS = INFLAMMATION
NSAID
CORTICOSTEROIDS
SULFASALAZINE
METHOTREXATE
TNF INHIBITOR DRUGS (ENBREL, REMICADE)
STIFF IN THE MORNING
BETTER WITH EXERCISE
STARTS IN LOW BACK AND MOVES UP
HURTS IN SI JOINTS OR “HIPS”
Once thought to be strictly a male disease, many experts think just as many females have AS. It might not be diagnosed as often due to tradition and sometimes presents or acts differently in females.
HLA stands for Human Leukocyte Antigen.
This is a fingerprint in your cells. Each of us has a different fingerprint or HLA typing.
HLA Groups A, B, C , D.
HLA B27 is present in about 8% of all of us.
Half of relatives of B27 people are also B27 positive.
Only 3% of B27 positives will get Ankylosing Spondylitis.
20% of first-degree relatives get it.
What causes some to get the disease and some not is not known. Experts believe infection with certain bacteria like one called Klebsiella is key.
Caucasians have a higher genetic tendency for this disease.
African-americans less so.