Ankylosing Spondylitis

Dealing With Flare-ups And Pain Associated With Ankylosing Spondylitis

Patients with the condition usually aren't athletic or involved in any physically demanding activities, usually they report sitting on hard surfaces for long periods of time, and also report frequently riding horses. Cardiovascular complications from this disease include aortic incompetence secondary to aortitis and more rare conditions such as conduction defects, cardiomyopathy, and pericarditis.

Patients generally are tested for a Chlamydia infection because recent studies have shown that early treatment of Chlamydia induced reactive arthritis may help reduce the progression of the disease. The doctor may look for bacterial infections by taking cell samples from the patient's throat as well as the urethra in men or cervix in women. Patients with Reiter's syndrome commonly develop inflammation where the tendon attaches to the bone, a condition referred to as enthesopathy. Enthesopathy may result in heel pain and result in the shortening and thickening of fingers and toes. Patients who give a history suggestive of a spondyloarthropathy should be tested for the HLA-B27 gene irrespective of the location of the uveitis and the number of reported episodes. Patients with a suggestive history should be screened for the gene even if they present a first episode of uveitis.

Symptoms of AS commonly begin in late adolescence and early adulthood, a normally productive time of life. If undiagnosed or inadequately untreated the consequences are continuous pain, stiffness, and fatigue. Symptoms may range from pain without swelling to a hot, swollen joint, where they may migrate from one joint to another or remain in several joints at the same time. Symptoms can improve with physical activity and the pain diminishes as bony ankylosis takes place.

Enthesopathy is one of the potential musculoskeletal sequelae and is characterized by pathologic and sometimes painful changes at the insertion sites (entheses) of tendons, ligaments, and articular capsules into bone. Enthesopathy affects the achilles tendon of the plantar fascia, and is frequently seen. Tenosynovitis usually affects the flexor rather than extensor tendons, while enthesopathy may result in heel pain and the shortening and thickening of fingers and toes. Some people afflicted with Reiter's syndrome also develop heel spurs, bony growths in the heel that cause chronic or long-lasting foot pain.

Despite the strongest association with a tissue antigen, HLA B27, the pathogenesis of AS remains poorly understood. Immunoregulatory genes and Gram-negative gut bacteria are thought to be important in disease expression, but despite such obvious manifestations, the variety of presentations and the insidious course of the disease can delay the diagnosis for years. The longer this disease progresses, the greater the risk of complications that will affect the cardiovascular, musculoskeletal, respiratory, neurologic, and endocrine systems.