Spondylitis - Ankylosing spondylitis
"Ankylosing spondylitis (AS)", is a kind of arthritis characterised by a chronic (i.e. for a long time) swelling of the joints of the spine. Usually, the sacro-iliac joint, that is, the joints which join the spine and pelvis is also affected. Sometimes, joints like the shoulder or hip joints are also affected. Rarely, the eye and bowels are also affected. The characteristic symptom of AS is a backache, although it may not be constant. As time passes, the stiffness of the affected joints usually gets worse. The word originates from the Greek words, "ankylos" meaning to unite or grow together, "spondylos" meaning vertebra and "itis" meaning inflammation.
The cause for ankylosing spondylitis is not known but it is supposed to be due to a combination of genetic and environmental factors. The specific human leukocyte antigen known as the HLA-B27 antigen is positive for most of these petients. It is believed to be an auto-immune or auto-inflammatory disorder.
The appearance of signs and symptoms in ankylosing spondylitis are gradual most of the time. It often occurs in between 20 and 30 years of age. It begins with a dull pain in the lower back or near the buttocks with stiffness of the lower back. The pain and stiffness may even wake up the patient early in the morning.
Ankylosing spondylitis can be diagnosed by radiological changes in the sacroiliac joints and spine but there are currently no blood or imaging tests to correctly diagnose early forms of ankylosing spondylitis (non-radiographic axial spondyloarthritis). Therefore, diagnosis of non-radiologic axial spondyloarthritis is not as easy and is based more on the signs and symptoms typical of the disease.
X-rays:The earliest sign can be observed with an X–ray and can show erosions and sclerosis of sacroiliac joints. With time, the erosions lead to widening of the joint space and bony sclerosis. An X-ray of the spine can show squaring of vertebrae with bony spur (growth) formation called syndesmophyte. This leads to the, "bamboo spine appearance". However, for these changes, a lot of time should elapse to be seen on a plain film X-ray.
Ankylosing spondylitis patients may show an elevation in the blood concentration of CRP and an elevation in the ESR, during acute inflammatory phases. However, there are many with ankylosing spondylitis whose CRP and ESR rates do not increase in this phase, so normal CRP and ESR results do not always correspond with the inflammation that is actually present. In other words, some ankylosing spondylitis patients have normal levels of CRP and ESR, despite having inflammation in their bodies.Genetic Tests
People who test positive for the HLA-B27 biomarker are at a greater risk than others of developing ankylosing spondylitis but not everyone with a positive HLA-B27 and backache need to be patients of ankylosing spondylitis. However, more than 85% of people diagnosed with ankylosing spondylitis are HLA-B27 positive.BASDAI
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), an index designed to detect the inflammatory burden of active disease helps to establish a diagnosis of ankylosing spondylitis when other factors like a positive HLA-B27, persistent buttock pain which resolves with exercise and X-ray or MRI showing involvement of the sacroiliac joints is present. It can be calculated easily.
Ankylosing spondylitis affecting children is known as Juvenile ankylosing spondylitis (JAS)and is a rare form of the disease that differs from the more usual adult form. Large joints of the lower extremities are more usually affected than the characteristic early morning backache seen in adult ankylosing spondylitis. Ankylosing tarsitis of the ankle is a usual feature, as is the more common findings of a negative ANA and RF in the serum, apart from a positive HLA-B27 allele. Affection of the appendicular joints can lead to a delay in diagnosis. However, other common symptoms of ankylosing spondylitis like uveitis, diarrhoea, sarcoidosis or fibrosis of the lungs and heart valve disorders can help in the diagnosis.
The pain and other symptoms can be managed
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