Frequently Asked Questions
Ankylosing Spondylitis
| Q. What chance do my children have of getting ankylosing spondylitis if I have it? |
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A. Genetics do certainly play a role in ankylosing spondylitis, but the chances are still low. The chance of inheriting the genetic marker of ankylosing spondylitis (HLA-B27) is 50% from the one parent with this gene. Studies suggest that only about 20% of people with the genetic marker, HLA-B27, develop the actual disease of ankylosing spondylitis. Therefore it seems that the risk of your child having AS is no more than 10% at most. |
| Q. How rapidly will my arthritis progress in AS? |
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A.There is a lot of variability in patients with AS. There may be acute flare-ups followed by remissions that show very little activity. In general, however, there is just a very slow progressive deterioration over many years. This can be controlled to a certain extent with the proper medication and therapy. |
| Q. Are women protected from AS? |
| A.Women are not protected, since up to 25% of cases of AS occur in women. In general, however, AS is slower to develop in women compared to men and generally a little milder. |
| Q. What is the best type of x-ray to show early evidence of AS? |
| A. Plain x-rays are certainly a poor way to diagnose ankylosing spondylitis in the early stages. Plain films will show the changes only when AS has been around long enough to cause significant erosions and damage of joints. The sacroiliac joints in the lower back may show the changes of ankylosing spondylitis first. MRI and CT scans may also be helpful in documenting early signs of irregularity or damage in the sacroiliac joints. These scans are costly, however, and should only be done if there is a high index of suspicion in the face of normal plain x-rays. Bone scanning can also be done which may suggest inflammation, but it is not specific for ankylosing spondylitis. MRI offers the advantage of no radiation exposure. |
| Q. Can AS affect other parts of the body? |
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A. There is an inflammatory eye condition called uveitis that can occur in up to 25% of patients with AS. Usually it just involves one eye and is characterized by redness and irritation. It is very important to treat this condition in order to prevent eye damage. Topical steroid eyedrops are usually helpful, but sometimes it is necessary to take steroid medication orally. Another possible complicating condition of AS is that of damage to cardiac tissue, especially the aortic valve of the heart. Neurologic symptoms might occur from arthritis involving the spine if this leads to pressure on the spinal cord or a nerve root. This might produce a sensation such as burning, numbness, tingling or weakness down the leg. |
| Q. Anti-inflammatory agents don't seem to be helping my pain. What can I try that would be stronger and more effective? |
| A. There are two major agents that have been used in severe ankylosing spondylitis. One is sulfasalazine and the other is methotrexate. Both agents work on the immune system and inflammatory system to try to achieve better control and possible remission. Sulfasalazine is the least toxic and seems to be useful especially when peripheral joints are involved besides the spine. Up to a 60% response has been seen in some series of cases. Methotrexate treatment has also shown some good responses. This agent requires more intensive monitoring, since it has possible harmful affects on the liver and may also lower one's blood counts. Certainly, more studies with higher numbers of patients are necessary to evaluate these medications, plus some of the newer immunosuppressive agents, in order to find the best treatments and outcomes in AS. |
| Q. What is the best exercise for my AS? |
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A. The best overall exercise appears to be swimming. In this way there is a lot of stretching of the spine and joints in a manner that does not put too much stress or strain on these areas. Swimming and aquatic exercise seem to encourage more extension of the spine, which is very important. The natural progression of ankylosing spondylitis is to eventually produce a bent-over curved spine, with the inability to straighten up to the full upright posture. Extension exercises are very important, such as arching the back and neck while lying on your stomach or by standing up against a wall so that your back, neck, head and shoulders are all touching the wall surface. Deep breathing exercises are also very important to allow for chest expansion and prevent breathlessness, since inflammation of the rib attachments to the spine and breast bone can lead to calcification and rigidity of the chest wall.
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