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Ankylosing Spondylitis (AS)

Ankylosing Spondylitis (AS) is a chronic and progressive autoimmune disease, which primarily affects the joints of the spine, causing inflammatory back pain and stiffness. The severity of AS can vary widely from one patient to another. Almost all patients will experience episodes of acute pain, known as ‘flare ups’ followed by periods when the symptoms temporarily subside. Treatment for AS can help to relieve pain, increase or maintain mobility and function, as well as prevent long term damage and complications.

Ankylosing Spondylitis Key Facts:

  • Ankylosing Spondylitis (AS) is a chronic, autoimmune disease that has no cure 1,2

  • AS is part of a family of diseases known as Spondyloarthropathies (SpA)3

  • Pain, stiffness, fatigue, and poor sleep are all symptoms of AS2

  • AS primarily affects the spine but can also affect other joints, tendons and ligaments, as well as eyes, lungs, bowel and heart2

  • Approximately 1 in 200 men and 1 in 500 women in Britain are affected by the disease2

  • AS is more prevalent in young men, affecting nearly three times as many men having it as women2

  • The disease typically affects people in their late teens and twenties, with the average onset age of 242

What is Ankylosing Spondylitis?

AS is a chronic and progressive autoimmune disease, which primarily affects the joints of the spine, causing inflammatory back pain and stiffness.2 It can also cause pain to the axial skeleton and large peripheral joints as well as ligaments and tendons. 2 The disease is associated with other inflammatory diseases of the skin, eyes and intestines including psoriasis, ulcerative colitis and Crohn’s disease.2 In its most severe form, AS can result in complete spinal fusion, which can cause severe functional limitation and the potential for deformity over time.2

Although the exact cause of the disease remains unknown, certain genetic, immune, and environmental factors may be involved. Research has shown that 96% of people with AS share the same genetic gene Human Leucocyte Antigen B27 (HLA-B27) in the UK.2 Ligaments or tendons become inflamed where they attach to the bone (enthesis), the bone then starts to erode (enthesopathy). As the inflammation subsides, healing begins and new bone develops. Restriction in movement, therefore, occurs as new bone formations replace ligaments or tendons.2

The severity of AS can vary widely from one patient to another. Almost all patients will experience episodes of acute pain, known as ‘flare ups’ followed by periods when the symptoms temporarily subside.4

Diagnosing Ankylosing Spondylitis

According to a study published in 2003, it can take on average 8 – 12 years for a diagnosis to be made, with those who are HLA-B27 positive getting to a diagnosis quicker than those who are HLA-B27 negative.5

General health and family history is important because AS can be hereditary6

Ankylosing spondylitis may or may not be associated with non-skeletal diseases such as uveitis (eye inflammation), prostatitis (prostate inflammation) and certain disorders affecting cardiac and pulmonary function6

Diagnosis for AS can be from a description of symptoms, physical examination, X-rays, and blood tests to look for signs of inflammation, and damage to the joints of the spine6

Physical examinations may include the Schober test, which tests the degree of lumbar forward flexion; the Gaenslen test which measures pain in a maneuver that stresses the sacroiliac joints; and neurologic evaluation – mandatory for patients presenting a spine disorder – which assesses pain, numbness, paraesthesias (e.g tingling), extremity sensation, motor function, muscle spasm, weakness, and bowel/bladder changes6 The Survey on Work is supported by a grant from Abbott Date of preparation: November 2009 AXHUR093068 7

Treatments for Ankylosing Spondylitis

Treatment for AS can help to relieve pain, increase or maintain mobility and function, as well as prevent long term damage and complications. Until recently, treatment has been limited to non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, but the development of cytokine inhibitors that inhibit the activity of tumour necrosis factor (anti TNFs) has been an important advance in treatment.1 Patients with AS are encouraged to stay active, to maintain flexibility and reduce pain. Physical therapy is recommended to provide daily exercises for the spine and breathing to prevent poor posture.

  • Non-steroidal anti-inflammatory drugs (NSAIDs): - are medications doctors commonly use to relieve inflammation, pain and stiffness7

  • Tumor Necrosis Factor (TNF) blockers: - this medication can help decrease inflammation by blocking one of the proteins that causes inflammation7

  • Physiotherapy: - can help maintain good posture, and deep breathing exercises, to enhance lung capacity. A physical therapist can also help patients to control heat and cold to help control pain and stiffness.7

  • Other Treatments: - alternative therapies such as yoga or acupuncture can help relieve pain and improve quality of life.7

The Burden to Society

Indirect costs: The onset of AS usually starts early in life, affecting young patients of working age. Sick leave, work disability and even withdrawal from work are increased for the AS population,8 adding to costs to the state in terms of incapacity benefit claims. A UK study reveals the total societal costs of AS per patient as total mean annual costs of £6,765 per patient, of which 58% were indirect costs9

Listen to a Podcast with Dr Rob Hicks and psychologist Professor Julie Barlow discussing ankylosing spondylitis. Click here

For more information please visit: visit www.nass.co.uk

References

1 McVeigh C.M, Cairns A.P. Diagnosis and management of ankylosing spondylitis, Br Med J. 2006; 333: 581–585.

2 Rogers F.J. The National Ankylosing Spondylitis Society, Guidebook for Patients, A Positive Response to Ankylosing Spondylitis, NASS, June 2004.

3 Ankylosing Spondylitis Research. Spondyloarthropathy Family. http://www.asresearch.co.uk/

spondyloarthropathies.htm. Last accessed November 2009.

4 Patient UK. Ankylosing Spondylitis, 2005. http://www.patient.co.uk/printer.asp?doc=23069007. Last accessed November 2009.

5 Feldtkeller E et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing Spondylitis. Rheumatol Int. 2003 23: 61–66

6 Spine Universe. Ankylosing Spondylitis: Description and Diagnosis, 2002. http://www.spineuniverse.com/

displayarticle.php/article1444.html. Last accessed November 2009.

7 Web MD. Ankylosing Spondylitis Treatment Overview, May 2009. http://arthritis.webmd.com/tc/ankylosing-spondylitis-treatment-overview. Last accessed November 2009.

8 Boonen A. Socioeconomic consequences of ankylosing spondylitis, Clin Exp Rheumatol. 2002; 20 (Suppl. 28): S23- S26.

9 Kobelt G et al. The burden of ankylosing spondylitis and the cost-effectiveness of treatment with infliximab (Remicade). Rheumatol. 2004; 43: 1158–1166.



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