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ANKYLOSING SPONDYLITIS

What is Ankylosing Spondylosis ?

The name for this condition comes from the Greek « ankylos » meaning stiffening of a joint and « spondylos » meaning vertebra. It is an inflammatory disease of the spine of unknown cause. The back is made up of vertebral bones likes blocks on top of each other. They are held together by fibrous strands called ligaments. Outside the ligaments, the muscles are also attached and act as guy ropes. The inflammation starts where the ligaments and muscle fibres join on to the bone. The bone responds by growing right into the fibres. As a result, the back loses its flexibility and gradually becomes rigid. Inflammation of joints can also occur in the sacro-iliac joints which connect the spine to the pelvis at the bottom of the back. These joints can fuse and further limit back movements. Other joints, ligaments and tendons around the body can occasionally also become inflamed. Inflamed joints are painful and stiff. Backache and stiffness are worse in the morning and improve with mild exercise. This may vary from month to month. When there is a lot of inflammation going on in the body, the patient may feel ill and tired and lose weight. Inflammation of the sacro-iliac joint gives pain and stiffness in the buttock and thighs.

Why does Ankylosing Spondylosis occur ?

It is not known for certain what starts ankylosing spondylitis. It is thought to be a reaction by the body to a virus. It is known that people who have the gene HLA B27 are more likely to get it. Almost all people with the disease have this gene, compared to only 1 in 10 of the general population. The disorder tends to run in families.

Treatment Involved for Ankylosing Spondylosis

Keeping up the correct posture is the most important aim of treatment. You will need to do exercises to keep as mobile as possible and to stop the spine becoming rigid in a bent position. A physiotherapist will detail exercises which will have to be done daily. Although they take time, they must take priority over other things. These exercises must be continued lifelong. A job involving a lot of stooping or back strain may be unsuitable and this should be discussed with the doctor. When the disease is active, resting and sleeping in a good posture position is also important. Anti-inflammatory drugs will relieve pain and inflammation. They often need to be taken when the inflammation is bad but can be stopped in between attacks. Some people need a small dose all the time to allow them to do their exercises and work easily. The drug sulphasalazine is known to have some benefit in people whose limb joints are affected by this condition. Another drug, methotrexate, was also shown in the past to have benefits and may be prescribed in your case. Surgery may rarely be needed particularly to replace damaged joints. The hips in particular may benefit from surgery. They are subjected to more strain if the back moves poorly.

During Treatment of Ankylosing Spondylosis

After a few months of inflammation, the disease gradually settles. It may leave you with some restriction of the spine. It is rare for the disease to progress so that the spine becomes very rigid. Most people do notice gradually less mobility in such movements as touching toes. In the first few months pain and stiffness are the main trouble. As the disease burns itself out it can leave a restricted spine and affected joints. It should be possible for you to carry on with normal work and a normal life. The disease does flare up and have quiet periods as well. Posture and exercise, sometimes with anti-inflammatory tablets, have to be varied with the activity of the disease. Anti-inflammatory tablets may cause indigestion if taken on an empty stomach. They may cause a rash or fluid retention. There are over 40 anti-inflammatory tablets which suit different patients differently. There is sure to be one to suit each patient. However, patients with a peptic ulcer are normally advised against them, since they can interfere with ulcer healing. You should make a point of seeing your rheumatologist and physiotherapist every 6 months to check posture, exercises and tablets.

If Ankylosing Spondylosis is Left Untreated

The disease is often very mild and even if untreated would lead only to a mild bend and stoop of the spine. If severe, the pain and stiffness would make work very painful. Before treatment was available, the stoop of badly affected patients used to be so severe that they could not look forward, and only down on the ground. This no longer occurs with current treatment methods.

Effects on Family of Ankylosing Spondylosis

They should provide the support and encouragement for you to do exercises and take tablets for many years. The children of someone with ankylosing spondylitis are more likely to be HLA B27 positive than other children. However, they are quite unlikely to get the disease. There is therefore no reason for unnecessary worry or screening.