Ankylosis Spondylitis and Lower Back Pain

Ankylosing Spondylitis, or AS as it is referred to by those who have it, belongs to the class of rheumatoid or autoimmune diseases, which also includes rheumatoid arthritis and lupus. It is characterized by unusual bone growth, usually in the spine, hips or legs, and by constant inflammation of the cartilage pads in between the vertebrae and of the sacroiliac glands (which are where the pelvis, tailbone and spine all meet up). This constant inflammation, the result of the body confusing the area for a foreign item and attacking it, causes debilitating pain, lowered quality of life, and can lead to severe restrictions on work and play.

Although some weblog and book account s have attributed a moving “phantom” pain to the disease, scientists at UCLA Medical Center disagree. The pain of AS may often radiate to other areas, causing, for instance, pain in the abdomen, lower chest, upper back, groin or legs, but the central symptom of the disease is the long-term pain of the lower back. As time goes on, however, the pain is replaced by something far more disturbing: bone growth and fusion. In extreme cases, AS patients are wheelchair bound with 70-80% of the spine fused and significant deterioration or fusion of the hips and pelvis.
The cause of the disease is not as yet known. Some scientists point to racial tendencies and indicate a recessive genetic link; indeed British medical examiners have traced a possible culprit down. Others believe that, like rheumatoid arthritis itself, the body for some reason has determined itself to be an enemy. There is roughly a 1 in 10 chance of a child of an AS sufferer contracting the disease.

Symptoms and Diagnosis

Typical symptoms can include:
� A slow of gradual onset of pain in the lower back, or a feeling of stiffness, generally taking weeks or months to develop
� Early morning stiffness or pain that goes away with exercise, but returns late in the day
� Persistent pain in the lower back, hips or pelvic region that lasts for more than three months.
� Loss of sensation in the upper thighs
� Feeling better after exercise and worse after rest
� Weight loss
� Fatigue
� Unexplained pain in the back of the heel that can be relieved by direct pressure

As with most rheumatoid diseases, diagnosis is by inference, not by direct evidence. Specialists generally order blood work, including C-reactive protein scans, as well as X-rays of the lower back. An MRI may also be ordered.

Treatments

In most cases AS is treated with medication, exercises and support from friends and family. Only rarely (about 6% of the time) will an individual need hip replacement or similar surgery, and it is even more rare that spinal realignment surgery is recommended. Over 80% of AS sufferers use non-steroidal anti-inflammatory medications; others manage the symptoms with over-the-counter pain medication and a few take an antirheumatic drug such as sulphasalizine.
In recent years in Europe, controlled testing of a new class of drugs known as TNF blockers has shown signs of effectiveness against AS. However, as the date of publication of this article, none of the TNF blockers have been approved for sale in the United States.

If You Think You Might Have AS

See your physician and explain your symptoms. It may be useful to him or her if you keep a log for several weeks, documenting physical health, level of activity and level of pain. He or she may also order numerous tests or screenings.
If you have the disease, do not despair. Vigorous exercise and medication assist in the majority of AS patients retaining mobility for many years. Support groups for both rheumatoid arthritis sufferers and AS patients are numerous. Ask your rheumatologist for contact points or look in the phone book for your area.

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