Whoever Heard of Ankylosing Spondylitis?

By Kathy Hubbard

Ankylosing Spondylitis. Nope, not characters in a Greek tragedy, but a rare chronic inflammatory arthritis. I first read about the condition in an obituary a month or so ago, and then the other night on the Spokane news there was a piece about a man with AS who’d had his tricked-out tricycle stolen. I hit the internet to find out what this disease is and what causes it.

“Ankylosing spondylitis is a form of ongoing joint inflammation that primarily affects the spine,” National Institutes of Health explains. “This condition is characterized by back pain and stiffness that typically appear in adolescence or early adulthood. Over time, back movement gradually becomes limited as the bones of the spine fuse together.”

Men are more apt to develop the disease than women. It’s part of a group of related diseases known as spondyloarthropathies. In the United States these diseases affect 3.5 to 13 per 1,000 people.

NIH says that it’s likely caused by a combination of genetic and environmental factors, of which most haven’t been identified. “However, researchers have found variations in several genes that influence the risk of developing this disorder.”

We’re not going to discuss gene mutations today, although I will put it on the list of future topics. But, I will say that the HLA-B gene provides instructions for making a protein that plays an important role in the immune system. It’s believed that HLA-B27 increases the risk of AS, although most people with this version of the gene don’t get AS. Don’t you love science?

“Although ankylosing spondylitis can occur in more than one person in a family, it is not a purely genetic disease,” NIH says. “Multiple genetic and environmental factors likely play a part in determining the risk of developing this disorder.”

Basically, ongoing research will someday figure out the whys, meanwhile it’s interesting to note that around 80 percent of children who inherit HLA-B27 from a parent with AS will not, I said not, develop the disorder.

The most common early signs of AS are chronic pain and stiffness in the lower back, buttocks and hips. This can develop slowly over weeks and months. Symptoms often begin between the ages of 17 and 35. The pain and stiffness may worsen while at rest or inactivity and improve when moving around. It’s often much worse in the morning and at night.

The Arthritis Foundation says that over time the 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 the bones fuse, the spine loses its normal flexibility and becomes rigid. The rib cage also may fuse, which can limit normal chest expansion and make breathing more difficult,” AF says. They go on to say that the inflammation and the pain can also affect the hips, shoulders, knees, heels, toes, ankles and fingers resulting in lessened dexterity and mobility.

Having AS is linked to a higher risk of heart disease and stroke. Smokers who have AS have more spinal damage than non-smokers.

“The disease can cause fever, loss of appetite, fatigue and inflammation in the lungs, heart and eyes. Eye inflammation (called iritis or uveitis) occurs in more than one-fourth of people with AS.” AF says.

The Mayo Clinic’s website says that during a physical exam your healthcare provider may ask you to bend in different directions to test the range of motion in your spine. X-rays and MRIs are employed to check changes in your joints, bones and soft tissues.

Obviously, the goal of treatment is to “relieve your pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversibly damage to your joints,” Mayo says.

Treatment will consist of medications and physical therapy. “Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright position,” Mayo explains.

The Spokane man had his trike returned and with it his mobility. By his stooped posture it was evident that the disease was somewhat debilitating, but his attitude was positive and I wish him all the luck.

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at [email protected].