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| ==Overview== | | ==Overview== |
| Ankylosing spondylitis is a chronic, painful, [[degenerative disease|degenerative]] inflammatory [[arthritis]] primarily affecting the [[vertebral column|spine]] and [[sacroiliac joint]]s, causing eventual fusion of the spine. It is a member of the group of the [[autoimmune]] [[spondyloarthropathy|spondyloarthropathies]] with a probable genetic predisposition. Complete fusion results in a condition known as '''bamboo spine,''' which is a complete rigidity of the spine, .<ref>{{cite journal | author = Jiménez-Balderas FJ, Mintz G. | title = Ankylosing spondylitis: clinical course in women and men. | journal = J Rheumatol | volume = 20 | issue = 12 | pages = 2069-72 | year = 1993 | id = PMID 7516975}}</ref>
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| ==Historical Perspective==
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| Ankylosing spondylitis was first recognized as a disease by [[Galen]]. In the late nineteenth century (1893-1898), however, the neurophysiologist [[Vladimir Bekhterev]] of Russia in 1893, [[Adolph Strümpell]] of Germany in 1897, and [[Pierre Marie]] of France in 1898, were the first to give adequate descriptions which permitted an accurate diagnosis of AS prior to severe spinal deformity. For this reason, AS is also known as Bechterew Disease or Marie–Strümpel Disease.
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| ==Pathophysiology==
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| Ankylosing spondylitis is a systemic [[rheumatic]] disease, and is one of the seronegative spondyloarthropathies. About 90% of the patients express the [[HLA-B27]] genotype. [[Tumor necrosis factor-alpha]] (TNF α) and [[IL-1]] are also implicated in ankylosing spondylitis. Although specific autoantibodies cannot be detected, its response to immunosuppresive medication has prompted its classification as an autoimmune disease.
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| ==Causes==
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| Ankylosing spondylitis needs to be differentiated from strain of lumbosacral joint, [[osteoarthritis]], [[Forestier's disease]] among others.
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| ==Epidemiology and Demographics==
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| In USA, the prevalence of ankylosing spondylitis is 250 per 100,000 and being a chronic condition, the incidence is low.
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| ==Risk Factors==
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| Patients with [[HLA-B27]] variant are at highest risk of developing ankylosing spondylitis.
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| ==Natural History, Complications and Prognosis==
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| Ankylosing spondylitis can range from mild to progressively debilitating. In a long-term undiagnosed period, [[osteopenia]] or [[osteoporosis]] of AP spine may occur, causing eventual compression fractures and a back "hump" if untreated. Due to the fusion of the vertrbrae, [[paresthesia]] may develop. Other complications are [[Aortic regurgitation]], [[Achilles tendinitis]], [[Heart block|AV node block]], [[amyloidosis]] and lung fibrosis.
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| ==Diagnosis==
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| ===History and Symptoms===
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| Ankylosing spondylitis typically presents in a young patient with chronic pain and stiffness in lower part of spine. In 40% of cases, ankylosing spondylitis is associated with [[iridocyclitis]] (anterior [[uveitis]], also known as iritis) causing eye pain and [[photophobia]] (increased sensitivity to light). Other common symptoms are recurring [[mouth ulcers]] (aphthae) and [[Fatigue (physical)|fatigue]].
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| ===Laboratory Findings===
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| There is no direct test to diagnose ankylosing spondylitis. There is increase in [[C-Reactive protein|C-reactive protein]] (CRP) and [[Erythrocyte sedimentation rate]] (ESR).
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| ===X Ray===
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| A clinical examination and [[X-ray]] studies of the spine, which show characteristic spinal changes and [[Sacroiliac joint|sacroiliitis]], are the major diagnostic tools for ankylosing spondylitis. The findings on X Ray are presence of subchondral erosions, sclerosis, proliferation on iliac side of SI joints and squaring of the vertebral body.
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| ===CT===
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| An option for more accurate (and much earlier) diagnosis of ankylosing spondylitis is [[Computed tomography|tomography]] of the sacroiliac joints. Joint erosions, [[subchondral]] [[sclerosis]], and bony [[ankylosis]] are better visualized on CT.
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| ===MRI===
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| The findings on MRI in a patient with ankylosing spondylitis is synovial enhancement. It is superior to CT in detection of cartilage, bone erosions, and [[subchondral]] bone changes. An increased T2 signal correlates with edema or vascularized fibrous tissue.
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| ===Other Imaging Findings===
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| Bone scintigraphy may be helpful in selected patients of ankylosing spondylitis with normal or equivocal findings on sacroiliac joint radiographs. The ratio of SI joint to sacral uptake of 1.3:1 or higher of the radionuclides is considered abnormal.
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| ==Treatment==
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| Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosing spondylitis. Physiotherapy and physical exercises are clearly preceded by medical treatment in order to reduce the inflammation and pain. NSAIDs, DMARD and TNFα blockers are the major types of medications used to treat ankylosing spondylitis. [[Surgery]] can be an option in ankylosing spondylitis in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky.
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| ==References==
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| {{reflist|2}} | | {{reflist|2}} |
| {{WH}} | | {{WH}} |