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Ankylosing spondylitis


Definition:

Ankylosing spondylitis (AS) is a long-term type of arthritis. It most commonly affects the bones and joints at the base of the spine where it connects with the pelvis.

These joints become swollen and inflamed. Over time, the affected spinal bones join together.

Alternative Names:

Spondylitis; Spondyloarthropathy

Exams and Tests:

Tests may include:

  • CBC
  • ESR (a measure of inflammation)
  • HLA-B27 antigen (which detects the gene linked to ankylosing spondylitis)
  • X-rays of the spine and pelvis
  • MRI of the spine and pelvis
Treatment:

Your health care provider may prescribe drugs (NSAIDs) to reduce swelling and pain.

  • Some NSAIDs can be bought over-the-counter (OTC), such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
  • Other NSAIDs are prescribed by your provider.
  • Talk to your provider or pharmacist before using any over-the-counter NSAID.

You may also need stronger medicines to control pain and swelling, such as:

  • Corticosteroid therapy (such as prednisone) used for short periods of time
  • Sulfasalazine
  • A TNF-inhibitor (such as etanercept, adalimumab, infliximab, certolizumab or golimumab)

Surgery may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on your back at night can help you keep a normal posture.

Outlook (Prognosis):

The course of the disease is hard to predict. Most people are able to function unless they have a lot of damage to the hips. Treatment with NSAIDS often reduces the pain and swelling. Treatment with TNF inhibitors appears to slow progression of the spine arthritis.

Rarely, people may have problems with:

  • Abnormal heart rhythm
  • Scarring or thickening of the lung tissue
  • The aortic heart valve
  • Inflammation in the large intestine (colitis)
  • Inflammation in the eye (iritis)
  • Psoriasis, a chronic skin disorder
When to Contact a Medical Professional:

Call your health care provider if:

  • You have symptoms of ankylosing spondylitis
  • You have ankylosing spondylitis and develop new symptoms during treatment
References:

Callhoff J, Sieper J, Weiß A, et al. Efficacy of TNFa blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis. Ann Rheum Dis. 2014. PMID: 24718959 www.ncbi.nlm.nih.gov/pubmed/24718959.

Inman RD. The spondyloarthropathies In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 265.

Sieper J, van der Heijde D, Landewé R, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009; 68:784. PMID: 19147614 www.ncbi.nlm.nih.gov/pubmed/19147614.

Yu D, Lories R, Inman RD. Pathogenesis of ankylosing spondylitis and reactive arthritis. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 74.


Review Date: 1/20/2015
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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