What is it?

Ankylosing Spondylitis is a rheumatic disease mainly affecting the spine and particularly the joint between the hip bone and the spine - a condition called sacro-ileitis.

How does it occur?

Following periods of inflammation, as healing occurs, bone grows out from both sides of the vertebrae (bones of the spine), and may join them together causing stiffness and immobility (bamboo spine).

What is the cause?

The cause is unknown but there are certain factors, which may predispose to the condition:

1. There is an increased incidence of Ankylosing Spondylitis in inflammatory bowel disease (around 10 - 20 times more common than would be seen in the general population).

2. If a first-degree relative has IBD, the chances of Ankylosing Spondylitis are increased.

3. There is a genetic tendency towards the disease. Around 90% of patients with Ankylosing Spondylitis have inherited the white cell group HLA-B27. However, many other members of the general population (including siblings of sufferers) also having this blood group, never develop the disease.

What are the symptoms?

Ankylosing Spondylitis is a progressive disease; i.e. it starts off with maybe only minimal effects, which gradually get worse over the course of time.

Early signs may show:

• low backache and stiffness
• aches and pains in the neck, shoulder and hip
• sciatica-type pain felt down the thigh

These may be mild and intermittent causing few troubles, or more active causing weight loss, fatigue and a general feeling of being unwell.

Other joints such as the hip, knee and ankle may be affected causing similar problems to those of the spine.

How do I know that I have the condition?

Diagnosis is uncommon before having been troubled by backache for several years. Tests, which eventually may lead to a diagnosis, include:

1. A blood test

The erythrocyte sedimentation rate (ESR) will be raised indicating inflammation.

2. X-rays

3. HLA-B27 antigen test

This is similar to blood grouping, but is looking at the white cells. If positive, this may indicate the possibility of the disease.

What is the treatment?

Treatment generally involves pain relief and keeping fit and healthy.

As mentioned previously, the disease is progressive and incurable, but symptomatic relief is achievable and a full life can usually be enjoyed.

Medical treatment

The aim of medical treatment is to relieve pain and inflammation. A variety of medicines is available and can be given in a number of ways, i.e. tablet, injection, suppository. Many of these drugs are slow release, thus having a longer and sustained effect. Local heat such as hot water bottles, heat lamps to an affected area may provide pain relief.

Surgery

Occasionally surgery may be carried out to provide movement in damaged hip joints. Rarely, the neck or back may be straightened if bending has become so severe that there is an inability to look forward. Other important factors include:

Posture

It is important to keep as good a posture as possible, keeping the back straight at all times.
• Avoid stooping over a desk at work.
• Avoid sitting in one position for too long without moving the back.
• Corsets and braces may make the condition worse as muscles that support the back may become weak due to immobility.
• A firm bed may provide more comfort in keeping the spine straight. A board can be applied under the mattress if necessary.

Sport and exercise

Keeping active is helpful. Swimming, in particular, allows good use of all muscles and joints without injury.

Diet

Research has shown that diet may have an affect on the treatment of Ankylosing Spondylitis. The organism Klebsiella has been isolated in stools of patients with active disease and improvements have been achieved by giving a low carbohydrate diet. These patients have also been found to be HLA-B27 positive.

Most cases of Ankylosing Spondylitis will gradually burn out and patients will be left with little more than a stiff back, which does not prevent general mobility. However, the importance of exercise, healthy eating to prevent obesity and maintaining good posture cannot be stressed enough.