Ankylosing Spondylitis: Systemic rheumatic disease that can affect multiple tissues, but commonly results in chronic inflammation of the spine and sacroiliac joints. Collagen calcifies and ossifies, replacing all cartilage of the affected area with bony tissue. Vertebral bodies become fused with bony bridges to adjacent vertebrae. Inflammation can affect many other organ systems, including the lungs, eyes, heart, kidneys, and gastrointestinal system.
Physical Assessment:
- Limited ROM is common; the thoracic vertebrae develop an inflexible forward curvature.
- Eyes, heart, lungs, nerves, and gastrointestinal system can be affected.
Diagnosis:
- X-rays are the single most important diagnostic test.
- A loss of joint space can be detected.
- More classic signs are the appearance of a “bamboo spine” as the vertebrae fuse.
- Nonspecific laboratory tests are often elevated: ESR, CRP, and alkaline phosphatase.
- Genetic marker for HLA-B27 is positive in the vast majority of cases.
Signs and Symptoms:
- Low back pain (centered over the sacrum) and morning stiffness in young adults.
- Eyes, heart, lungs, nerves, and gastrointestinal system can be affected.
Treatment:
- Physical therapy and exercise reduce pain and stiffness and improve posture, joint mobility, and lung capacity.
- NSAIDs; naproxen and indomethacin can be used with corticosteroids used as an adjunct.
- TNF-blocking medications, such as anakinra, and IL-17 inhibitors, such as secukinumab, are effective.