ankylosing spondylitis

Unlike rheumatoid, ankylosing spondylitis (AS) is an inflammatory disorder that is primarily affects the spine. This inflammatory joint disease may cause some of the vertebrae to fuse together. In extreme cases the discs calcify, giving the spine a 'bamboo spine' appearance on X-ray, as it becomes progressively less flexible.

As part of the inflammatory process the lumbar spine inward arching curve (the lordosis) flattens, tipping the upper body forward, in front of the line of gravity. Left unchecked, this can cause one of the most alarming aspects of AS, where the head and upper body can become so far permanently stooped forward that the upper body is parallel to the ground and it is impossible to look straight ahead.

There is no specific blood test to confirm that you have AS. Your blood may demonstrate that you have the HLA-B27 gene, but most people who have that gene don't have ankylosing spondylitis.

The progressive calcification of the spine in ankylosing spondylitis can give the typical 'bamboo spine' appearance on X-ray 

There is no cure for ankylosing spondylitis, although you will see below that there are specific things that you can do to make life more liveable and slow the progression. AS often starts off with pain in the sacroiliac joints where the two dimples can be seen either side at the back of the pelvis. The pain typically presents at night, or in the early hours of the morning and you get up stiff and creaky. It affects men more than women, with signs and symptoms often coming on in early adulthood. Inflammation also can occur in other parts of your body — such as your eyes and bowels.

what are the medication options for ankylosing spondylitis?

NSAIDs Nonsteroidal anti-inflammatory drugs such as naproxen (trade name Naprosyn) and indomethacin (Indocid) are the most common drugs of choice for managing AS. They control the pain, inflammation and associated stiffness, however both drug types can cause unpleasant side effects, such as nausea and gastrointestinal bleeding. 

Tumor necrosing factor blockers (TNF) If NSAIDs are not helping then your doctor may suggest TNF drugs. They target protein to help reduce the pain and swelling of inflamed joints. They are administered by injecting the medication under the skin or through an intravenous line. They too are a strong drug. They can reactivate tuberculosis and cause neurological problems.

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