Ankylosing Spondylitis
In this condition factsheet:
Diagnosing Ankylosing Spondylitis
Your doctor will make the diagnosis of AS based a combination of your symptoms, an X-ray or another type of imaging of your affected joints, and certain blood tests. The earliest sign is sacroiliitis (inflammation of the sacroiliac joint). It can be seen on an X-ray of the pelvis, or it can be detected at an even earlier stage with an MRI scan.
If you have AS, the X-ray will show areas where the bone has been worn away by the condition. The vertebrae of the spine may start to fuse together because the ligaments between them become calcified. The term for bones growing together due to inflammation is ankylosis, and this is where the name ankylosing spondylitis comes from ("spondyl" refers to the spine and "itis" means inflammation). A physical exam for AS includes the Schober test to assess the flexibility of the spine, which can be abnormal even when it's not obvious to the person.
Your doctor may also do a blood test for HLA-B27, as well as a test called erythrocyte sedimentation rate (ESR) or a C-reactive protein test (CRP). A high ESR or CRP is a sign of conditions with inflammation, such as AS. However, it does not definitely mean that you have AS, since many other conditions can also cause a high ESR or CRP, and two-thirds of people with AS have a normal ESR.
Since back pain and osteoarthritis are common and AS comes on gradually, there is often a long delay in recognizing AS, especially among doctors who are not specialized in rheumatology (the study and treatment of arthritis and other diseases that affect joints, muscles, and bones).
Treating and Preventing Ankylosing Spondylitis
Currently, there is no cure for AS, but it can be managed using medications, surgery, and physiotherapy.
Rheumatologists are the most specialized and experienced doctors in the diagnosis and management of AS and other spondylopathies.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen*, naproxen) work by reducing inflammation, which helps relieve the pain, stiffness, and swelling of AS. They do not slow down the progression of the condition; in other words, they don't stop the disease from getting worse. Possible side effects of NSAIDs include nausea, abdominal pain, asthma, liver damage, heart problems, high blood pressure, stomach ulcers, and bleeding.
Corticosteroids (e.g., prednisone, triamcinolone, methylprednisolone) taken by mouth are rarely used to treat AS; however, steroid injections into the affected joints may be used. They relieve symptoms by reducing inflammation but do not affect spinal changes. Corticosteroids do not slow down the progression of the condition. Side effects of the injection include joint damage (if the injection is used too often) and infection. Corticosteroid eye drops may also help in treating short-term inflammation in the eyes.
Biologics, (e.g., adalimumab, etanercept, golimumab, infliximab, certolizumab, secukinumab) are used to relieve signs and symptoms of the condition, including symptoms in the spine. Some biologics can also help to improve physical function for people with AS. They can slow or stop the progression of the disease, but they may not work for everyone. They work by neutralizing specific proteins in the body which are involved in causing inflammation. Biologics are given as an injection under the skin (a subcutaneous injection) or as an injection into the vein over a period of time (an intravenous infusion). Possible side effects include infusion reactions (e.g., rash, flushing, headache, and difficulty breathing), irritation at the injection area, nausea, headache, vomiting, diarrhea, fatigue, joint pain, or an increased risk of serious infection (including brain infection). There have also been reports of multiple sclerosis and systemic lupus erythematosus.
Disease modifying antirheumatic drugs (DMARDs; e.g., methotrexate, sulfasalazine) are used to relieve AS symptoms and slow down the progression of the condition. DMARDs may be beneficial to people with peripheral AS. They do not relieve inflammation in the spine, but they reduce inflammation in other joints. Possible side effects include nausea, diarrhea, increased risk of infections, liver damage, lung damage, and bleeding.
Make sure you understand and discuss all the risks and benefits of taking any medications before you start them.
Surgery
Surgery may be used to repair joint damage or replace damaged areas. For example, some people with AS may need a hip replacement.
Physiotherapy
A physiotherapist can show you special exercises to improve your flexibility, strength, and mobility. If the disease is not slowed or stopped, regular exercise and supervised physical therapy are essential to maintain a working posture once the spine becomes fused – it is far better to be stiff upright than bent over.
All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Ankylosing-Spondylitis
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