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Hi. Welcome to HealthiNation. I’m Dr. Preeti Parikh. You might think that chronic pain
in the lower back is a problem brought on by…just the wear and tear of daily life
and our sedentary living. But there are those including young adults who experience pain
in the neck, back or hips that is due to a condition called ankylosing spondylitis. It’s
an inflammatory disease that typically affects the spine, but can also effect other joints
and organs throughout the body. As it progresses, ankylosing spondylitis, or A-S, can bring
on serious complications such as immobility of the neck, back or hips.
In this video series, we’ll look at what ankylosing spondylitis is and its underlying
pathology, how it’s diagnosed, and finally, the treatment options for those who have the
back, neck, and sometimes hips. The name comes from the Greek words ankylos meaning the stiffening
of a joint and spondylitis that means inflammation of the vertebra. A-S causes inflammation between
the joints and can lead to bones becoming fused together. In the most severe cases,
it can lead to a hunched-over posture and limited motion, making it difficult to engage
in many of the activities of daily living.
A-S is primarily an inflammatory process in the region where the ligaments, tendons and
joint capsules attach to the bones. These regions are called an entheses and thus the
inflammatory condition is known as enthesitis. During enthesitis, good bone in the regions
under attack, the back, hips, or neck is destroyed, while new bone is created. The swelling and
the new bone that is created bridges across these areas, causing fusion of bone, and lack
of mobility and flexibility result.
A-S symptoms typically appear in early adulthood, between the ages of 20 to 30.
One of the most common first symptoms of A-S is gradual pain and stiffness in the spine,
typically in the lower back. This pain and stiffness is generally worse in the morning
after rest, but improves with activity throughout the day. The pain also typically awakens one
from sleep in the second half of the night. As the disease progresses, the flexibility
of the back is reduced, leading to a lack of mobility that makes simple tasks, like
bending over or tying shoes, difficult to do.
Someone with A-S may also experience hip pain. As well as joint pain in the shoulders, knees
or ankles. People who have the disease may also experience generalized fatigue, made
worse by the difficulty of getting a good night’s sleep due to pain. They may have
difficulty breathing due the inability to fully expand their rib cage, also causing
fatigue. Further, someone with A-S may have a low-grade fever and experience some weight
loss.
There are also other conditions associated with A-S. These are called extra-articular
complications – meaning they are not related to the joints. One is inflammation of part
of the eye called anterior uveitis. It can cause pain, blurred vision and sensitivity
to light. It’s the most common extra-articular condition for people with A-S, occurring in
25 to 40 percent of patients.
Neurological problems can develop too. The bones of the spine protect the spinal cord
and spinal nerves. So, patients with A-S have an increased risk of spinal cord injury because
their spinal bones are weakened and are at increased risk of fracturing, which can lead
to pressure on the spinal cord. This is called spinal cord compression--symptoms include
changes in sensation and mobility below the level of compression.
Another associated condition is inflammatory bowel disease, or IBD. Five to 10 percent
of people with A-S also have IBD, while four to 10 percent of people with IBD have A-S.
IBD is common among people who have A-S because of a genetic correlation between them. Other
ailments associated with A-S include cardiovascular disease, pulmonary disease, kidney disease
and lesions in the lining of the bowel. Ankylosing spondylitis is a chronic condition, but a
proper diagnosis and early treatment can help to relieve pain and ease symptoms.