Ankylosing Spondylitis Health Article

Definition

Ankylosing spondylitis (AS) is a systemic disorder that refers to inflammation of the joints in the spine. AS is the primary disease in an entire group of conditions known as seronegative spondylarthropathies. It is also known as rheumatoid spondylitis or Marie–Strümpell disease (among other names). AS is an autoimmune disease, as are most forms of arthritis. By definition, other joints, in addition to the spine, can also be affected, including the shoulders, hips, knees, and feet. Tissues in the eye can also be affected.

Description

A form of arthritis, AS is characterized by chronic inflammation, causing pain and stiffness of the back, progressing to the chest and neck. Eventually, the whole back may become curved and inflexible if the bones fuse, which is known as "bamboo spine." Other conditions associated with AS include reactive arthritis, psoriatic arthritis, spondylitis of inflammatory bowel disease, and undifferentiated spondyarthropathy. AS may involve multiple organs, such as the:

• eye (causing an inflammation of the iris, or iritis)
• heart (causing aortic valve disease)
• lungs
• skin (causing a scaly skin condition, or psoriasis)
• gastrointestinal tract (causing inflammation within the small intestine, called ileitis, or inflammation of the large intestine, called colitis).

Less than 1% of the population has AS; however, 20% of AS sufferers have a relative with the disorder.

Causes & symptoms

Genetics, in the form of a gene named HLA–B27, can play an important role in the disease, but the precise cause of AS remains unknown. According to information from the Spondylitis Association of America, HLA–B27 is a perfectly normal gene found in 8% of the general population. Generally speaking, no more than 2% of people born with this gene will eventually get spondylitis. The gene itself does not cause spondylitis, but people with HLA–B27 are more susceptible to getting spondylitis. To date, 15 subtypes of HLA–B27 have been identified. The most common subtypes in the United States being B27.05, and then after that B27.02. The way in which HLA–B27 interacts with some other proteins seems to be very important to the cause of AS, but further research must be conducted to find out exactly how. According to information published in 1997 from The Arthritis Cure, by Dr. Jason Theodosakis, M.D., M.S., M. P. H., and others, research was being conducted regarding the possibility that a certain type of infection could be the trigger for the onset of AS.

Symptoms of AS include:

• low back and hip pain and stiffness
• duration of symptoms longer than three months
• difficulty expanding the chest
• early morning stiffness improved by a warm shower or light exercise
• pain in the neck, shoulders, knees, and ankles
• low-grade fever
• fatigue
• weight loss

AS occurs most often in males between 16 and 35 years of age. Initial symptoms are uncommon after the age of 30, although the diagnosis may not be established until after that age. The incidence of AS in African Americans is about 25% of incidence among Caucasians, but is rarely seen in that population.

Some naturopathic healers link the cause of AS to its autoimmune origins in food allergies and abnormal bowel function, sometimes referred to as "leaky gut" syndrome. According to this theory, food allergies combine with the leaky gut and, according to the Healing-With Nutrition website, from a 1986 article in the Britain Journal of Rheumatology, "..result in the increased circulation of gut-derived antigens into other areas of the body. The body produces antibody-antigen complexes (immune complexes) characteristic of RA (rheumatoid arthritis) to battle these gut-derived foreign antigens; but these antibody-antigens are thought to also cross-react with antigens in the joint tissues. In other words, the antibodies formed to attack the (leaky gut) microbes also cross-react and attack joint collagen."

Diagnosis

Doctors usually diagnose the disease simply by the patient's report of pain and stiffness. Doctors also review spinal and pelvic x rays since involvement of the hip and pelvic joints is common and may be the first abnormality seen on the x ray. The doctor might also order a blood test to determine the presence of HLA–B27 antigen if the x rays have not clearly determined the diagnosis. If the gene is present, it could facilitate the accuracy of the possible AS diagnosis. When a diagnosis is made, patients may be referred to a rheumatologist, a doctor who specializes in treating arthritis. Patients may also be referred to an orthopedic surgeon, a doctor who can surgically correct joint or bone disorders.