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Posted by on Sep 19, 2014 in blog, Spine | 0 comments

Ankylosing Spondylitis

Ankylosing Spondylitis


What connects former English cricket team captain Michael Atherton, the Russian chess champion Vladimir Kramnik, the gorgeous French tennis player Tatiana Golovin, and the late Pope John Paul II from Poland? No, it is not that none of them were born in India.

They all have/had ‘bamboo spine’, a disease that affects mobility of their axial skeleton, mainly the spine and big joints. Ankylosing spondylitis is an inflammation within the joints of the spinal column, leading to the loss of spinal movements and fusion between all vertebrae. The Greeks discovered this condition: in Greek, ankylos means ‘bent’, and spondylos means ‘vertebrae’. Today, doctors classify this under a group called spondyloarthropathy. It has no relation with rheumatoid arthritis though.

Is it dangerous?
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis of autoimmune origin, meaning your immune system attacks itself by mistake, and you get sick as a result. It can range from mild to progressively debilitating, and from medically controlled to refractive. Some have periods of active inflammation followed by times of remission, while others never have periods of remission, but have acute inflammation and pain.

If not controlled, this fusion of the spine will lead to great weakness. In later stages, AS can also affect other organs like the heart, lungs, kidneys, large intestines and eyes.

All in the family
Approximately 90 per cent of AS patients express the HLA-B27 genotype, meaning that there is a strong genetic association. However, only five per cent of individuals with the HLA-B27 genotype contract the disease. Doctors look out for this genotype to help their diagnosis; CT scan and MRI are also made use of. Still, as AS is sporadic in nature, medical science is yet to find out the exact cause of the disease.

Do you have it?
Men are more affected than women, with a ratio of 3:1. Early appearance of symptoms leads to faster and more severe effect of the disease. The common complaints are:

  • Back pain
  • Stiffness
  • Difficulty in turning on the side in bed
  • Loss of flexibility

Watch out for neck and shoulder pain, as they are the first signs to appear. Low backache comes later, and increases once present. Some people do get heel pain, dry eyes, fatigue, weight loss, hip and shoulder stiffness

The Challenge

It is a challenge to operate and anaesthetise AS patients due to the particularity of their spine. Spinal fixations are required in cases of spinal trauma where the natural fusion is damaged, causing neurological symptoms to appear.

  • Epidural steroids are useful for pain relief and eliminate the need for regular medication.
  • Hip replacements are required in late cases of hip arthrosis.
  • Spinal corrective osteotomies are sometimes required to correct too much forward bending.

What is the cure?

Though there is no known cure, AS can be controlled with:

  • Regular exercises: Stretching, exercise, Yoga and swimming are useful in preventing stiffness and also improving mobility.
  • Routine anti-inflammatory drugs: Ibuprofen, diclofenac, COX-2 inhibitors, oxicams, etc. reduce inflammation and thus, the pain.
  • Some immune modulator agents: Methotrexate, sulfasalazine, and corticosteroids are used to reduce the immune system response through immunosuppression. TNF alpha blockers like etanercept, infliximab and adalimumab are proved to control the disease, but are very expensive and carry risk of infections.
  • Local measures like heat therapy, massage and physiotherapy are very useful.

Exercises and regular medication under the supervision of the treating physician can make a patient with ankylosing spondylitis live a near normal life, and with normal life span. There are no issues with fertility and childbirth.

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