Ankylosing Spondylitis: Knee, Hip and Spine Pain

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Ankylosing Spondylitis, previously known as Bechterew's disease and Marie-Strumpell disease, is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it may be difficult to breathe deeply. The signs and symptoms of ankylosing spondylitis often appear gradually, most commonly between 15 and 45 years of age. Ankylosing spondylitis occurs in 1 in 200 people.

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The basic pathologic lesion of ankylosing spondylitis occurs at the entheses, which are sites of attachment to bone of ligaments, tendons, and joint capsules. Enthesopathy results from inflammation, with subsequent calcification and ossification at and around the entheses.

In the synovial joints, a proliferative chronic synovitis indistinguishable from rheumatoid arthritis may occur; however, subchondral bone and cartilage are invaded by reactive tissue originating from the bone, which is a feature not encountered in rheumatoid arthritis.

There are more than 100 types of these diseases, including ankylosing spondylitis (AS), rheumatoid arthritis, and lupus. Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse your vertebrae together, limiting movement. Symptoms can worsen or improve or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help.

Facts and Statistics

• Ankylosing spondylitis occurs in 1 in 200 people.
• AS symptoms may also present differently in woman.
• The onset of the disease is typically between 15 and 25 years of age.
• The disease is most prevalent in Northern European countries, and seen least in people of Afro-Caribbean descent.
• Many rheumatologists believe the number of women with AS is under-diagnosed, as most women tend to experience milder cases of the disease.
• The majority of people with AS, including 95 percent of white people with the disease, express the HLA-B27 antigen and high levels of immunoglobulin A (IgA) in the blood.
• Ankylosing spondylitis is two to three times more common in males than in females.
• In women, joints away from the spine are more frequently affected than in men.
• Ankylosing spondylitis affects all age groups, including children.

The severity of AS varies greatly from person to person, and not everyone will experience the most serious complications or have spinal fusion. Some will experience only intermittent back pain and discomfort, but others will experience severe pain and stiffness over multiple areas of the body for long periods of time. A thorough physical exam including x-rays, individual medical history, and a family history of AS, as well as blood work including a possible test for HLA-B27 are factors in making a diagnosis.

The type of physician who primarily diagnoses and treats ankylosing spondylitis and related diseases is called a rheumatologist. Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis.

Recent studies show that the new biologic medications can potentially slow or halt the disease progression in some people. In 1982 at the Middlesex Hospital in London, Professor Alan Ebringer and his team began trials to assess the effectiveness of a new Ankylosing spondylitis diet approach to treating AS.

The life expectancy of patients with ankylosing spondylitis is the same as that of the general population, except for patients who are severely affected with the disease and in whom complications develop.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.

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