Ankylosing Spondylitis (AS) is a chronic progressive inflammatory rheumatic disease that primarily affects the spine (axial skeleton and sacroiliac), but can also affect other joints of the body. The inflammation of the spine can cause severe, chronic pain and discomfort. The majority of the cases occur in men younger than 45 years of age, although the disease affects both men and women. The overall approximate percentage of affected people is 0.5% worldwide. The cause of AS is unknown, but we do know that genetics play a role and that the pathogenesis is incompletely understood. Testing positive for the HLA-B27 marker suggests an increased risk as does a family history of AS.
Ankylosing Spondylitis can cause inflammation, pain and stiffness in other areas of the body such as the shoulders, hip, ribs, heels and small joints of the hands and feet. Sometimes the eyes can become involved (known as iritis or uveitis) and rarely the lungs and heart can be affected. The course of the disease varies greatly from patient to patient and not everyone will experience the most serious complications of the disease, such as fusion of the spine.
The common treatment plan for AS includes physical therapy, the use of anti-inflammatories, an exercise routine, as well as the use of heat/cold to relax the muscles and relieve joint pain. The second line of treatment choices include disease modifying anti-rheumatic drugs (DMARDS) and biologic agents such as TNF blockers.
Patients who are experiencing lower back pain along with inflammation of the joints in other parts of the body should seek the assistance of a rheumatologist to confirm or exclude the diagnosis of this condition.
Author: Norman B. Gaylis, M.D., F.A.C.P., M.A.C.R.