| Ankylosing Spondylitis is one of the more common | | | | stiffness as well as maintaining function.A |
| forms of arthritis affecting about 0.5% of the | | | | comprehensive program consists of a combination of |
| population. It affects men more often than women in | | | | anti-inflammatory medicines to help with symptoms |
| a ratio of about 2.4-5:1. The disease is categorized as | | | | as well as disease-modifying therapy to slow down |
| a "spondyloarthropathy"... a type of arthritis that | | | | the rate of progression. Examples of |
| preferentially affects the spine. It usually starts in the | | | | anti-inflammatory drugs are drugs such as ibuprofen |
| sacroiliac joints- the joints that join the pelvis to the | | | | (Motrin), naproxen (Naprosys), nabumetone (Relafen), |
| low back- and spreads upwards to involve the rest | | | | etodolac (Lodine), meloxicam (Mobic), and celecoxib |
| of the spine. Peak age of onset is between 15 and | | | | (Celebrex). Disease-modifying drugs that are used |
| 30 years.Typically, a patient will complain of stiffness | | | | extensively for this condition are sulfasalazine |
| in the low back or neck or both that is worse with | | | | (Azulfidine) and methotrexate. Biologic therapies like |
| rest and better with activity. Often, a young person | | | | etanercept (Enbrel), adalimumab (Humnira), and |
| will pursue sports as a way to relieve the pain they | | | | infliximab (Remcade) are considered important for |
| have! Stiffness during the day after inactivity is also | | | | inducing remission. A solid program of physical therapy |
| common. Other joints affected include the hip, knee, | | | | to help with range of motion is also mandatory.For |
| wrists, shoulders, elbows, and ankles. Fatigue is a | | | | patients with suspected eye disease, close |
| very common symptom. Occasionally low grade | | | | supervision by an experienced ophthalmologist is also |
| fever, appetite loss, and weight loss may be | | | | recommended.Patients with far-advanced disease |
| seen.Patients will sometimes present with the | | | | may suffer complications including compression of the |
| extra-articular (outside of the joint) symptoms. | | | | spinal cord (cauda equina syndrome), and fractures of |
| Examples include inflammation of the eye, lungs, and | | | | the neck. In particular, care should be exercised in |
| rarely, the heart. The most common extra-articular | | | | preparing patients with AS for surgery. Intubation |
| symptom is eye inflammation which occurs in about | | | | (placing a breathing tube into the airways) for general |
| 40% of patients and must be diagnosed and treated | | | | anesthesia carries the risk of inadvertent spine |
| aggressively. Blindness is a dreaded complication.The | | | | fracture.Surgery is reserved for far advanced cases |
| physical exam will show limitation of range of motion | | | | that have not responded to medical therapy.The |
| in the low back. Chest expansion is also restricted | | | | clinical course and prognosis is highly variable and also |
| since many patients with AS will have limited ability to | | | | highly dependent on the rapidity of diagnosis and the |
| expand their lungs due to involvement of the thoracic | | | | effectiveness of therapy.Dr. Wei (pronounced "way") |
| spine.Occasionally, women with AS will have more | | | | is a board-certified rheumatologist and Clinical Director |
| symptoms in the neck than the low back.Laboratory | | | | of the nationally respected Arthritis and Osteoporosis |
| testing will show abnormalities that indicate the | | | | Center of Maryland. He is a Clinical Assistant |
| presence of inflammation. Patients with AS will also | | | | Professor of Medicine at the University of Maryland |
| have the genetic marker HLA B27 in about 90% of | | | | School of Medicine and has served as a consultant to |
| cases.Imaging studies such as magnetic resonance | | | | the Arthritis Branch of the National Institutes of |
| imaging will show the presence of inflammation in the | | | | Health. He is a Fellow of the American College of |
| sacroiliac joints. Inflammation of the tendon insertions | | | | Rheumatology and the American College of |
| at different affected joints will also be | | | | Physicians. |
| evident.Treatment goals consist of relieving pain and | | | | |