ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is a form of arthritis that primarily affects the entire spine, although it may involve the hips and shoulders. It usually affects young men, and there seems to be a genetic link. Back pain is the most common symptom, and it may be quite difficult to make the correct diagnosis in the early stages of the condition. Most of the usual blood tests for arthritis are normal. In the later stages of the condition, radiographic (x-ray) findings can be quite dramatic, showing complete fusion of the spine. This may cause the patient to walk in a stooped posture. Ankylosing spondylitis can have features such as eye irritation, heart problems, and spinal cord compression. A decreased ability to expand the chest can be another early finding.

Ankylosing spondylitis is a gradually progressive disease, and it can result in serious impairments. Precautions include sleeping without pillows to prevent the neck from fusing in an abnormally flexed position. If this happens, it becomes difficult to see straight ahead when walking or driving. Physical therapy, including water therapy, is combined with use of medications such as aspirin and antiinflammatory drugs to minimize deformity and pain.

Nonsurgical treatment is geared toward preventing fusion in undesirable positions. Physical therapy is important but possibly not cost effective. Analgesics and antiinflammatory drugs can be effective in managing the pain. Surgical treatment involves cutting the bones in the spine to realign the body into a functional position. This is a complex surgical procedure with considerable risk, and patient and surgeon should choose this option with care. The hips are sometimes involved, and replacement arthroplasty may be needed.

• Maintain as much motion as possible to prevent fusion in an awkward position.
• Perform regular non-weight-bearing exercise.

• Do not spend long periods in a poor posture, particularly with the head hanging forward.

• If you fall and notice a sudden change in the alignment of your neck or back, whether or not you are feeling pain.

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