Barry Fox - Arthritis For Dummies

© John Wiley & Sons, Inc.

FIGURE 4-2:Normal vertebrae compared to those with ankylosing spondylitis.

AS currently affects some 300,000 Americans, with its favorite targets being Caucasian men between the ages of 16 and 35. The disease often runs in families and has been linked to a certain genetic marker (HLA-B27), although 80 percent of those with this gene never develop the disease. Something else (perhaps an infection) is undoubtedly triggering it.

AS generally comes on gradually, as pain or stiffness settles into the lower back or hips, and the places where tendons and ligaments attach to the spine. Problems can also develop with the neck, shoulders, hips, knees, and back of the heel. The pain may be worse at night or upon arising, then recede once the person begins to move around. AS symptoms can be fairly constant or come and go.

A systemic disease, AS can cause compression fractures to the vertebrae, eye problems, loss of appetite, fatigue, and fever. There may also be difficulty in taking a deep breath, damage to the aorta (the body’s largest artery), and problems caused by pressure on the nerves.

No one, single test can detect AS, so diagnosis is usually made from a combination of symptoms and family history, a physical examination, blood tests showing inflammatory markers and/or the HLA-B27 gene, and MRIs or X-rays, which can reveal characteristic joint damage or extra bone in the spine or sacroiliac joints of the pelvis.

Treatment is aimed at relieving pain and inflammation and preventing or correcting deformities of the spine to preserve spinal flexibility. NSAIDs are prescribed to ease inflammation, pain and stiffness. But one of the most exciting developments in rheumatology over the last few years is the effectiveness of biologics in treating ankylosing spondylitis, including tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira) and etanercept (Enbrel), and interleukin-17 (IL-17) inhibitors such as secukinumab (Cosentyx) and ixekizumab (Taltz). These and other biologics have been found to improve mobility and possibly fight the progression of AS (you can read more about them in Chapter 8).

Though AS has no cure, most who have the disease suffer from mild to moderate symptoms and do fairly well. Physical therapy can be very helpful in preserving spinal strength and flexibility. More extreme cases of AS may require surgical replacement of one or more joints, but spinal surgery is rarely indicated as the spines of AS patients are so fragile.

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