(NC)—A form of arthritis, foreign to many people, called ankylosing spondylitis (AS), affects 150,000 to 300,000 Canadians. Dr. Stephanie Keeling, a rheumatologist from the University of Alberta, provides answers to common questions to help shed some light on this potentially debilitating disease.
Q. What is ankylosing spondylitis?
A. Ankylosing spondylitis is a chronic inflammatory form of arthritis and the most common site of involvement is the sacroiliac, or SI, joints on the right and/or left sides in the buttock area.
Q. Who is at risk of developing AS?
A. AS affects young people in the prime of their life between the ages of 15 and 30 and usually affects men three times more often than women. It is uncommon for AS to first present in people over the age of 40.
Q. What causes AS?
A. The exact cause of ankylosing spondylitis is not known. However, AS has a hereditary component; we inherit our tissue type from our parents the same way we inherit our hair colour and blood type. Some tissue types although found in the general population are more frequently found in people with AS
Q. What are the symptoms of AS?
A. The most common symptom of AS is long–term, low back pain along with spinal stiffness in the morning or after a long period of inactivity. In young people the presence of tender points at specific locations around the feet, heels, knees and hips can be signs of AS. Since AS often affects young, active males, it is sometimes misdiagnosed as mechanical low back strain. Other common symptoms of AS include:
• Back pain and stiffness that appears over weeks or months, rather than hours or days
• Constant pain for more than three months (as opposed to coming on in short attacks)
• Feeling better after physical activity and feeling worse after rest
• Weight loss, especially in the beginning
• Feeling feverish and experiencing night sweats
In a lesser number of individuals, pain does not begin in the spine but rather starts in a hip, knee or shoulder joint. This can be confusing when there is no back pain present and may initially look like some other form of arthritis.
Q. How is AS diagnosed?
A. The history of the onset of pain, the areas of involvement and the times of day when pain is worst, are all factors in achieving an accurate diagnosis. There is no blood test that diagnoses AS specifically, but blood tests may be done that could contribute to the overall diagnosis. Also, X–rays can be helpful in the later stages of the disease as over time the lower back joints , called the sacro–iliac or SI joints will usually show changes that cannot be seen on the X–rays initially. In addition to the SI joint X–ray changes, changes at the edges of some vertebrae along the spine maybe observed.
Q. Why is early diagnosis of AS important?
A. As is the case with most forms of inflammatory arthritis, early diagnosis and treatment of AS can be key factors in preventing disability and deformity; if the inflammation associated with AS continues unchecked, changes to the spinal column are likely to result, causing spinal immobility and limitation of range of movement. If AS affects the hips, damage can result in the need for total hip replacement surgery.
Q. Is there a cure for AS?
A. At the moment, there is no cure for AS. Our goal with treatment is to minimize a patient's pain and to maintain their mobility and function.
Q. Can AS be treated?
A. There are many treatment options available today to help lessen the pain and stiffness and make movement easier for patients. Some of the more common ones include biologics, nonsteroidal anti–inflammatory drugs, disease–modifying anti–rheumatic drugs and corticosteroids.
Q. Are there any new treatment options available to patients?
A. Research into the disease area is ongoing and there are effective treatments available in Canada that offer patients more convenience and ease of use. Speak to your doctor.
Q. Where should I go for more information on AS?
A. If you have been experiencing chronic long–term back pain, speak to your family doctor.