CLINICAL SYMPTOMS: Ankylosing spondylitis (AS) is a chronic arthritic condition that usually begins early in life in the late teens or early twenties. It is characterized by symptoms of significant morning stiffness, aching and pain in the low back and pelvis, especially in the sacroiliac joints. Pain may first be on one side of the body, but usually progresses over time to include both sides. Morning stiffness in the low back is especially prevalent in this disorder. There may be some fatigue, and over time, there can be swollen, painful, arthritic joint symptoms throughout the extremities, especially in the hips or knees. Heat and exercise tend to improve the pain and stiffness of the low back. Pain may also run down the legs and mimic "sciatica." If untreated the back pain and stiffness progressively worsen to the point of severe restriction of movement in the low back, even leading to trouble in maintaining an upright posture. When the chest wall is affected, patients may note some breathlessness with exertion.

_________________________________________________

_________________________________________________

There is no specific diagnostic blood test for AS, but there does seem to be a genetic predisposition to AS, as seen by the positive genetic marker, HLA?B27, found in the majority of patients with AS (95%). The sedimentation rate is often elevated, showing inflammation to be present in the body. There may be some minor anemia present, but generally all other blood test results are within normal limits. X-rays are helpful in the diagnosis of AS. The significant x-ray findings of AS include calcification at the insertion sites of ligaments and tendons on bones, especially around the lower spine. The sacroiliac joints tend to become calcified and may be fused as well. Joint space narrowing may occur in certain arthritic joints involved, such as the hip, knee or shoulder. Bone scanning, MRI, and CAT scans may show arthritic changes when plain x-rays are normal early on in the course of the disease.

_________________________________________________

The diagnosis of AS is made after noting the characteristic abnormalities present on physical exam and x-ray and by having negative blood tests and lab studies for other inflammatory connective tissue diseases, such as rheumatoid arthritis and lupus. A positive HLA-B27 antigen also may help support this diagnosis. The exact cause of AS is uncertain, but there appears to be some role played by infectious agents. Some studies have shown evidence of microbes such as Chlamydia in the cells of the joint capsule. It is felt that there are certain genetically susceptible people who are prone to having AS and might come in contact with the right germ or environmental agent that activates the disease process of AS. More studies are being done on this, and antibiotic treatment is being evaluated.

_________________________________________________

The treatment of AS includes both medication and proper exercise. The main goal, besides the relief of pain and inflammation, is to prevent complete calcification and deformity of the spine. By starting anti-inflammatory medication early on and by maintaining the proper therapeutic exercise program, patients can often maintain adequate mobility and function. Nonsteroidal anti-inflammatory agents are usually helpful, along with a physical therapy and exercise program. In severe progressive cases, immunosuppressive medications may be necessary to help get better control of the disease process. These may include agents such as sulfasalazine or methotrexate. Steroid medication may also be necessary in severe cases.

The prognosis for ankylosing spondylitis is generally good if the disease is treated at an early stage and if the patient is faithful with the exercise program and medications. Certainly when spinal deformity has occurred from severe calcium buildup in the spine, the quality of life can be quite poor. Therefore, one should contact their primary care physician or rheumatologist as soon as possible when persistent symptoms of back pain, aching and stiffness occur. On a proper treatment regimen, generally satisfactory control and patient function are achievable in many patients.