Ankylosing spondylitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ankylosing spondylitis can range from a mild to progressively debilitating disease. If the disorder is not diagnosed early in its course, osteopenia or osteoporosis of the spine may occur, causing eventual compression fractures and a back "hump" if left untreated. Due to the fusion of the vertebrae, paresthesia may develop. Other complications are aortic regurgitation, achilles tendinitis, AV node block, amyloidosis, and pulmonary fibrosis.

Natural History

AS can range from mild to progressively debilitating, and from medically controlled to refractive.

Unattended cases of AS normally lead to knee pain, and may be accompanied by dactylitis or enthesitis, which may result in a misdiagnosis of normal rheumatism. In a long-term undiagnosed period, osteopenia or osteoporosis of AP spine may occur, causing eventual compression fractures and a back "hump" if untreated. Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays, an abnormal bone outgrowth similar to osteophytes, affecting the spine. Due to the fusion of the vertrbrae paresthesia is a complication due to the inflammation of the tissue surrounding nerves.

Organs affected by AS, other than the axial spine and other joints, are commonly the heart, lungs, colon, and kidney. Other complications are Aortic regurgitation, Achilles tendinitis, AV node block and Amyloidosis. Due to lung fibrosis, chest X-rays may show apical fibrosis while pulmonary function testing may reveal a restrictive lung defect. Very rare complications involve neurologic conditions such as the cauda equina syndrome.[1]

Complications

Rarely, people may have problems with the aortic heart valve ( aortic insufficiency, aortitis) and heart rhythm problems.

Some patients may have pulmonary fibrosis or restrictive lung disease.

Entheseal-resident T cells are sensitive to IL-23 overexpression and they respond vigorously by releasing IL-17 and IL-22 which lead to local inflammatory changes and osteoblast-mediated bone remodeling. These T cells are also present in the aortic root and valve, leading to aortitis that may be seen in patients with ankylosing spondylitis.

Prognosis

Prognosis of ankylosing spondylitis varies from person to person. Most patients can maintain a good function. While other patients may lose daily functions. Prognosis depends on:

  • Onset age: The early onset age, the worse prognosis will be.
  • Whether organs outside joints are affected.
  • Whether the patient is treated in time.
  • Whether the patient is got physical therapy.

References

  1. Nicholas U. Ahn, Uri M. Ahn, Elizabeth S. Garrett; et al. (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments.". J of Spinal Disorders. 14 (5): 427–433. PMID 11586143. 

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