Ankylosing spondyloarthritis

Ankylosing spondylitis is autoimmune inflammatory disease that primary affects spine or back, hips, sacroiliac and humeral joints. In AS, the joints and ligaments that normally let the back move and flex become inflamed. The inflammation produces pain and stiffness, usually beginning in a lower back. With time the disease may progress into the upper spine, neck, knees, ankles, and chest. As a result the joints and bones may grow together (fuse) causing the spine to become rigid and inflexible. AS may be a chronic (long-lasting) disease. The severity of symptoms and disability vary from person to person. Early diagnosis and proper treatment control the pain and stiffness, and prevent joints deformity.

As a rule disease affects young men at the age of 16-35. The disease is less common in women, who often have milder symptoms that are more difficult to diagnose. About 5% of people with AS develop it in childhood and begin in the hips, knees, heels and big toes, and later progress the spine. Boys are more likely to have AS than girls.

The cause of AS is still unknown, but heredity is important. HLA-27 gene is found in 90% of AS patients. It one of the genes that play an important role in the body’s immune system, which defends against infection. Other HLA-27 positive people are healthy carries of this gene. If HLA-27 gene carrier doesn’t have relatives with AS, he has only 2% chance of getting disease , and If HLA-27 carrier has parents or close relatives with AS his chance increases to 20%.

Symptoms: the illness starts from inflammation of hips, sacroiliac joints and lumbar part of spine and manifests with pain and stiffness. Pain increases at night and relives after active movements and physical exercises. Over time pain and stiffness may progress to the upper spine and even into the rib cage and neck. Ultimately, the inflammation can cause the sacroiliac and vertebral bones to fuse or grow together. When bones fuse, the spine and neck loose their normal flexibility and become rigid. The rib cage may also fuse, which can limit normal chest expansion and make breathing more difficult. The heels may be affected, making it uncomfortable to stand and walk on hard surfaces.

AS is a systemic disease, it means it can affect other body organs. The disease can cause fever, loss of appetite, fatigue, and inflammation of eyes (with pain, redness, and photophobia), heart, aorta, lungs. There can be fever, weakness, appetite decrease. Ophthalmologist is to treat eyes problems. Diagnose of AS is based on clinic symptoms, X-ray and CT showings, and carriage HLA-27 gene definition.

The symptoms of AS may be similar to those that occur with other conditions such as psoriasis, inflammatory bowel disease or Reiter’s syndrome. Proper diagnosis is important, so you can get the right treatment.

Very important is early start of treatment, before manifestation of irreversible changes in spine and joints. Treatment for AS focuses on reducing pain and stiffness, preventing deformities and helping you continue your normal activities.

Medications are essential and ongoing part of treatment for AS.
Nonesteroidal anti-inflammatory drugs like indomethacin, dyclophenac, ortophen, meloxicam improve quality of life, helps maintain a good posture.
Disease – modifying antirheumatic drugs like sulfosalazine, methotrexat also may slow and stop progression of the disease.

Regular exercises are important part of overall AS management. Physical therapists of our clinic, experienced in treating arthritis, can design a program of exercises to meet you needs. They’ll teach you to live comfortably with AS. Physical training can be individual or in group. Training combines kinesiotherapy, isometric and post-isometric relaxation, Yoga therapy. Exercises that strengthen the back and neck will help maintain or improve your posture. Deep breathing exercises and aerobic exercises will help keep you chest and rib cage flexible. Swimming is a good option for patients with AS, because it also helps you spine, neck, shoulders and hips stay flexible and encourages deep breathing.

Complex of physiotherapeutic procedures together with physical exercises and drugs treatment can preserve flexibility of your spine, especially if treatment started in time. Doctors of our Health Clinic designed our own complex of treatment for AS, the high light of out treatment is combination the number of natural physical factors which have determined frequency, amplitude and length. Complex of treatment combine ultrasound with anti-inflammatory gel or ointment, red and infrared laser with metabolic influence, quantum therapy, electrotherapy using Chattanooga apparatus. Electrotherapy decreases pain, inflammation, swell, and increases spine and joints structures blood supply and metabolism. It also prevents spine and joints ligament ossification.
Some simple advices for AS patients:
warm bath and shower relaxes joints and muscles if you suffer stiffness;
start your exercises gradually and do them until you fill light pain or fatigue;
to prevent ankylosis (bones and joints fusion) maintain proper body position while you are standing or sitting or slipping;
sleep on hard mattress. Try to sleep on your back with a thin pillow or one that just support the hollow of your neck. Keep your legs straight instead of sleeping in curled position. Keep back straight as much as you can with your shoulders squared and your head up while you are working, sitting before computer and etc. You can test whether your posture is correct by standing with your back against the wall; your heels, buttocks, shoulders and head should be able to touch the wall at the same time;
corsets and braces usually don’t help in treating AS. Maintaining right posture and exercising are more effective. Begin your exercises slowly and plan to do them when you are the least tired and have the list pain;
sit straight while you are working, adjust surface of your working table the way to sit straight;
change your positions often. Move around at least every hour. Use cushion if sitting is painful;
arrange the rest periods throughout the day, doing exercises during the day will preserve your flexibility for a long time;
if your job involves prolong stooping or excessive strain on your back, you may want to consider a job change.

A photographic series of a patient with ankylosing spondylitis was taken over a period of 26 years. By 1957 a thoracic kyphosis has become apparent, and loss of the normal lumbar lordosis has occurred. There are early flexion contractures of the hips and knees. In the next two sequences, increasing flexion contractures of the hips and knees have occurred along with progressive ankylosis of the spine. In 1973, bilateral total hip arthroplasties were performed, which improved the patient's posture.

Ciliary injection and irregularity of the pupil are present. Adhesions between the iris and lens (synechiae) appear at the 1-o'clock and 4-o'clock positions. Synechiae are caused by repeated episodes of iritis and may eventually lead to glaucoma and blindness. The pupil is dilated from medication. The medial aspect of the sclera has been blanched by topical medication.

This anteroposterior projection of the lumbar spine shows the characteristic changes of syndesmophyte formation or "bambooing." Ossification is present deep to the lateral collateral ligaments, and it follows the contour of the intervertebral disc spaces. This ossification involves the outer layers of the intervertebral disc (annulus fibrosus). In contrast, degenerative spurs will extend almost at right angles to the vertebral bodies, rather than snugly following the contour of the disc as in ankylosing spondylitis.

Poor postural habits can increase pain and stress on the neck and spine in patients with ankylosing spondylitis. Principles of good posture should be taught and practiced. Self-checks such as height and occiput-to-wall distance should be done regularly. Stretching exercises to improve and maintain a functional posture can be done throughout the day, with the simplest being chin tucks and pectoral stretching in the corner. Guidelines for good posture while