Ankylosing Spondylitis

Ankylosing Spondylitis, also known, as Marie-Strumpell disease is a chronic progressive form of arthritis. It is primarily an inflammatory disease that affects the spine, the tissues on either side of the spine, and possibly the larger joints of the body, such as the hips and shoulders. Later, as the disease develops there may be some involvement of the knees as well.

The onset of the disease usually starts with periods of low back pain and an achy feeling, mostly in the lumbar and sacroiliac regions of the spine. There may also be radiating pain into the lower extremity, if the sciatic nerve becomes involved. The individual usually will awake with morning stiffness of the back, with difficulty in bending and any type of movement without feeling achy and painful.

As the disease progresses, the symptoms will worsen and will start to spread to the mid and upper back. At times the spread will affect the neck as well. Further along in the disease, the knees, elbows and other peripheral joints may be affected.

The individual may start to experience weight loss, fatigue, and muscle stiffness. They may develop a mild anemia. The individual has to see their healthcare provider for a complete physical examination and evaluation. The examination will include x-rays and blood tests.

As the disease becomes more advanced, the normal concave lumbar curve will become flattened. This occurs in response to the muscle spasms that can be ongoing. The patient feels as they have a poker in their back. The vertebrae start to develop arthritic outgrowth of bone, and as these outgrowths of bone meet, they will develop an ankylosis, or bridging. What this means, is that they will become fused, or welded together. This fusion prevents normal movement of the spine because they will move as a unit, and hence, the name, “poker spine”.   As the name “poker spine” denotes, the individual will lose all flexibility when bending, due the involvement of all the vertebrae.

Along the course of the disease, the costovertebral joints can also become involved. Should this occur, there will be difficulty in expanding the chest. Breathing will become impaired to some degree, causing a reduction in vital capacity. This involvement further aggravates the individuals feeling of fatigue.

Ankylosing spondylosis is an insidious disease that can start as early as 10 to 30 years of age, occurring more frequently in males. It is unusual to start after the age of 30. The disease will have its onset during 10 to 30 years of age, and should there be any untoward symptoms, it is imperative that the individual see their healthcare provider.

An early diagnosis of the disease, will allow the individual to start measures that will slow the progression of the disease. These preventive measures will only tend to slow the ensuing stiffness, and not result in a cure. At some future point, possibly in 10 to 20 years there may be a remission.

It is up to the individual to start an ongoing exercise program. This should also be discussed with their healthcare provider. The program should include stretching, bending and flexion exercises. These exercises should stress full range of motion movements to keep the joints, muscles and ligaments as supple and as flexible as possible.

Getting enough rest is important, and enough sleep is imperative. It is during the sleep period that nature will repair the damages occurring during the wakeful hours. The patient should sleep on their back on a firm mattress, so that the spine is not in flexion. A pillow should not be used if at all possible so the neck is not flexed. If a pillow is used, it should be a thin pillow.

Heat packs to the back can be beneficial and should be used as often as possible. These heat packs used before exercising will be of benefit, allowing the muscles, joints and ligaments to move more freely and with less restraint. Applying a good analgesic gel can be very helpful and soothing as well.

It is important to remember that this is an ongoing disease, however, it is equally important to know that much can be done to help in maintaining an active lifestyle.