Ankylosing spondylitis (AS); also known as Bechterew disease; Marie Strumpell disease), an autoimmune seronegative spondyloarthropathy, is a painful chronic inflammatory arthritis punctuated by exacerbations (‘flares’) and quiescent periods. It primarily affects the spine and sacroiliac joints and eventually causes fusion and rigidity of the spine (‘bamboo spine’). Ankylosing spondylitis varies widely in prognosis and outcome. It is also associated with ulcerative colitis, Crohn’s disease, psoriasis and Reiter’s syndrome (uveitis).
Ankylosing spondylitis occurs in 1% of men and 0.5% of women in Caucasians. It is more prevalent in males with a peak age onset of 20–30 years. Men tend to have more severe spinal and pelvic disease, whereas women have peripheral joint (knees, wrists, ankles, hips) involvement. Symptoms develop before the third decade of life in 80% of patients with AS. Less than 5% of patients develop AS in the fourth decade. Juvenile onset (age 10–16 years) AS is a more severe disease and occurs in 4%of AS.
The initiating cause of AS is not known but environmental factors (unidentified bacterial or viral agents), susceptibility genes (HLA-B27), gender, age and ethnicity play a role. Overall, sporadic AS is more severe than familial disease. Although only 5% of HLA-B27 positive individuals develop AS, 90–95% of patients with AS possess HLA-B27 alleles.
Ankylosing spondylitis is characterised by sacroilitis, peripheral arthropathy, enthesopathy (pathological changes at the sites of insertion of ligaments and tendons), and the absence of rheumatoid factor. The symptoms of AS usually begin between the ages of 15 and 40 years with persistent pain and morning stiffness (worse at rest but improves with exercise) in the lower spine and the sacroiliac joints.
Extra-articular manifestations are associated with more severe AS and those relevant to anaesthesia involve the cardiovascular system, lungs and skin.
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I was curious as to what bamboo spine looked like compared to a healthy spine. I found this image of a bamboo spine and thought it would interesting to compare it to a normal spine. The bony bridge of the bamboo spine is shown.
ReplyDeleteBamboo spine:
http://www.chiropractic-help.com/images/Bamboo-spine.jpg
Healthy spine:
http://thumbs.dreamstime.com/thumb_416/1246904738TcsU7n.jpg
This obviously sounds like a painful disease, but I found it interesting that pain and stiffness can be improved by exercise. Any ideas why? It would seem more intuitive to me that the impact of exercise would cause more pain to progressively stiffening joints.
ReplyDeleteHeather, I think exercise is recommended because the joints in this disease become fused (ankylosed) so the more you exercise, the less deformity that will result. In the old days when people never exercised if they had arthritis, people with AS were often bent over. In rheumatoid arthritis, where there is a lot of joint inflammation, exercise may be much too painful until the disease is brought under control.
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