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Ankylosing spondylitis

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VOL: 102, ISSUE: 22, PAGE NO: 23



- Ankylosing spondylitis is a chronic form of arthritis that affects the spinal column and results in a fusing of the vertebrae.



- It varies in severity and can have long periods of remission.



- The majority of people with ankylosing spondylitis are able to lead fully independent lives but may lose some flexibility in the spine. However, those severely affected can lose movement in the spine and neck and sometimes the ribs.



- It mainly affects younger males and has an incidence of one in 2,000.



- Ankylosing spondylitis occurs when the spinal ligaments and tendons swell. When this swelling reduces, new bone growth fills the space left behind leading to fusing of the vertebrae.



- The exact causes of the condition are not understood. However, there may be a genetic component as the majority of those affected carry the antigen HLA-B27. It is thought that this causes the immune system to attack the spine, resulting in inflammation. However, not all those affected carry HLA-B27.



- Ankylosing spondylitis has also been known to develop after prolonged periods of bedrest.



- The symptoms of ankylosing spondylitis can be intermittent and vary from person to person. It most often begins at the sacroiliac joint, resulting in lower back pain. This can also cause pain in the buttocks and the backs of the thighs.



- The fusing of the vertebrae may cause a stoop in some people or a straight, stiff back in others.



- As the spine becomes increasingly rigid, the pain may subside but the spine will be more susceptible to fracture.



- In a minority of people whose ribs are affected, breathing can become difficult.



- Other joints can be affected, including the hips, knees and shoulders, and occasionally the smaller joints in the hands and feet. This may cause aching and swelling.



- Symptoms are often worse in the morning.



- Other symptoms may include:



- Loss of appetite;



- General feeling of being unwell;



- Occasional inflammation of the eye (iritis).



- Diagnosis is based on the area, type and progression of the pain.



- A blood test can be performed to rule out other conditions such as rheumatoid arthritis and identify the presence of HLA-B27.



- Treatments include:



- Exercise - the condition responds well to gentle stretching and swimming. Hydrotherapy and physiotherapy are recommended for loosening the joints and increasing mobility;



- Medication - non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce the inflammation in the joints;



- A minority of people with severe ankylosing spondylitis require surgery such as hip replacements. However, there is no surgical option for the spinal deformities caused by severe ankylosing spondylitis.

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