What does ankylosing spondylitis mean?

Ankylosing means fusing together. Spondylitis indicates inflammation of the vertebrae. Both words come from the Greek. So, AS describes the condition by which some or all of the joints and bones of the spine fuse together. Entire fusing of the spine is unusual. Many people will only have partial fusion, sometimes limited to the pelvic bones.

What exactly is AS?

AS is a painful, progressive, rheumatic disease. It mainly affects the spine but it can also affect other joints, tendons and ligaments. Other areas, such as the eyes, lungs, bowel and heart can also be involved.

Is ankylosing spondylitis the same as spondylosis?

No. They sound similar but they are different. Spondylosis is a term relating to “wear and tear” and is more common in older people. AS relates to an inflammatory condition which produces new bone and leads to fusion. The vigorous exercise therapy designed for people with AS might be harmful to those suffering from spondylosis.

Is AS common?

AS affects approximately 1 in 200 men and 1 in 500 women in Britain.

Who gets AS?

Men, women and children can all suffer from AS. It typically strikes people in their late teens and twenties, with the average age being 24. However, symptoms can start at other periods of life. AS is more common in men, with nearly three times as many men having it as women.

What are the symptoms of AS?

Typical symptoms of AS include:

  • Slow or gradual onset of back pain and stiffness over weeks or months, rather than hours or days.
  • Early-morning stiffness and pain, wearing off or reducing during the day with exercise.
  • Persistence for more than three months (as opposed to coming on in short attacks).
  • Feeling better after exercise and feeling worse after rest.
  • Weight loss, especially in the early stages.
  • Fatigue.
  • Feeling feverish and experiencing night sweats.

Does AS affect other joints?

Yes. AS sometimes causes aching, pain and swelling in the hips, knees and ankles. Indeed, any joint can be affected. In most cases the pain and swelling will settle down after treatment. It is particularly important to stretch the hip joint to prevent stiffening in a bent position making you lean forward. The heel bone can become particularly troublesome causing pain in two areas. Most common is the under surface, about three centimetres from the back of the foot. This is called plantar fasciitis and can last for many weeks. It may respond to an insole for the shoe designed to take weight off that part of the heel. The less common pain arises at the back of the heel where the Achilles tendon is attached to the heel bone. Pressure from the shoe may aggravate the pain.

Does AS affect other organs?

Yes. AS can sometimes affect the eyes, heart and lungs. These effects are not life-threatening and they can be treated with relative ease.

How does AS affect the eyes?

AS can cause inflammation of the iris and its attachment to the outer wall of the eye, the uvea. 40% of people will develop iritis or uveitis on one or more occasions. Usually the first symptom is a slight blurring of vision in one eye but the main symptom is a sharp pain together with a dramatically bloodshot eye. To avoid permanent damage you should receive prompt treatment. It is a good idea to go straight to a casualty department, rather than to your GP, where you can be treated by an ophthalmology team. Tell them that you have AS. They will give you eye-drops which will reduce the inflammation in a matter of hours. Continue treating yourself with the eye-drops for as long as the inflammation persists.

How does AS affect the heart?

Very occasionally AS can have a mild effect on the heart. In most cases this is so mild that it is difficult to detect. AS may cause the aortic valve to leak. More commonly, though, it affects the conduction of electrical activity within the heart. Usually any such problems are unnoticed by the person with the condition.

How does AS affect the lungs?

AS should not make you any more susceptible to lung or chest infections. However, it may affect the rib joints and the muscles between the ribs making breathing, sneezing, coughing or yawning painful. As a result, the lungs fail to become fully ventilated. You will find some advice in the exercise section of this booklet to help you maintain normal chest wall movement. Sometimes the lungs may get scarred, a condition know as apical pulmonary fibrosis. This will show up on an X-ray but does not usually cause any symptoms. In the late stages of AS the chest wall may become quite fixed and affect air entry in and out of the lungs. This does not mean you stop breathing! The diaphragm muscle continues to work and your stomach moves in and out as you breathe. Large meals and tight clothing will increase the effort of breathing so you may find it more comfortable to avoid these. It is also vital to avoid smoking since this will not only make breathing more difficult but it could cause potentially serious lung and chest infections.

Does AS affect everybody the same way?

No. AS is a very variable disease. Some people have virtually no symptoms whereas others suffer more severely. However, at NASS we know that those patients who follow an appropriate course of exercises tend to do better than those who don’t.

What causes AS?

We’re not entirely sure. So far medical research has shown that 96% of people with AS in Britain all share the same genetic cell marker – Human Leucocyte Antigen B27 (HLA-B27). It is possible that some normally harmless micro-organism, which on this occasion the immune system cannot fight, comes into contact with HLA-B27 and sets up an adverse reaction. Sometimes bowel infections appear to spark off AS. Symptoms may also become apparent after a period of enforced bed rest, for example following a car accident, accelerating a previously existing mild condition. A group of symptoms known as Reiter’s Syndrome may also lead to AS. These include iritis (or uveitis) which is inflammation of part of the iris; and conjunctivitis which causes red, gritty and painful eyes. People with Reiter’s Syndrome also suffer from urethritis. This is inflammation of the urethra, the tube that conveys urine from the bladder out of the body. This results in pain on passing urine, discharge on the end of the penis (especially on waking up in the morning) and an increased frequency of passing urine. Women may get the pain but won’t notice a discharge from the urethra. Reiter’s Syndrome also results in arthritis, affecting the large joints, especially in the legs

The Spine

The spine is made up of 24 vertebrae and 110 joints. There are 3 sections: 7 cervical, 12 dorsal or thoracic and 5 lumbar vertebrae. The cervical, or neck section, is the most mobile. In the thoracic section each vertebrae has a rib attached to it on each side. Below the lumbar section is the diamond-shaped sacrum which locks like a keystone into the pelvis. The joints between the sides of the sacrum and the rest of the pelvis are called the sacroiliac joints. This is usually the starting-point of the condition where the low back pain and AS begin.

Information Courtesy of:
The National Ankylosing Spondolitis Society
For Further information visit the website
www.nass.co.uk

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