Ankylosing spondylitis (AS) is a chronic, progressive inflammatory arthritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.

AS is characterised as a spondyloarthropathy (SpA).

Signs and symptoms

The typical patient is a young man of 15-30 years old (although women are also affected) with pain and stiffness in the spine. It is also associated with iridocyclitis (anterior uveitis), ulcerative colitis, psoriasis and Reiter's disease, through HLA-B27 (see below).

Organs affected by AS, other than the axial spine, are the hips, heart, heels, and other areas (peripheral).

Diagnosis

The diagnosis is by X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis . A normal X-ray does not exclude the disease.

HLA-B27 is occasionally used, but does not distinguish AS from other diseases and is therefore not of real diagnostic value.

Epidemiology

In the USA, the prevalence is 0.25%, but as it is a chronic condition, the number of new cases (incidence) is fairly low.

The sex ratio is 3:1 for men:women.

Therapy

Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosating spondylitis.

Medications used are:

• NSAIDs - anti-inflammatory and pain-reducing
• Steroids
• DMARDs - immunosuppressants

Alternative therapies are:

• Diet - starch free diet (Ebringer et al 1996), london diet, Paleolithic diet
• Stretching - yoga, pilates
• Exercise - swimming, jogging, etc.

Prognosis

AS can range from mild to progressively debilitating, and from medically controlled to refractive.

Pathophysiology

AS is a systemic rheumatic disease, and about 90% of the patients are HLA-B27 positive. HLA-DR and IL1ra are also implicated in ankylosing spondylitis. Although specific autoantibodies cannot be detected, its response to immunosuppresive medication has prompted its classification as an autoimmune disease.

Hypotheses on its pathogenesis include a cross-reaction with antigens of the Klebsiella bacterial strain (Tiwana et al 2001). Particular authorities argue that elimination of the prime nutrients of Klebsiella (starches) would decrease antigenemia and improve the musculoskeletal symptoms.

See also

• NASC, the AS patients' federation
• NIAMS, the National Institute of Arthritis and Musculoskeletal and Skin Diseases

Reference

• Tiwana H, Natt RS, Benitez-Brito R, Shah S, Wilson C, Bridger S, Harbord M, Sarner M, Ebringer A. Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis. Rheumatology (Oxford) 2001;40:15-23. PMID 11157137.
• A. Ebringer, C. Wilson. The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis. Clinical Rheumatology 1996 Jan;15 Suppl 1:62-66. PMID 8835506.

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