Ankylosing spondylitis: diagnosis and treatment

Ankylosing spondylitis can be a debilitating disease and a difficult one to diagnose for different reasons. Here are tips on what to expect in the diagnosis process and treatment process.

As mentioned, ankylosing spondylitis can be a challenging disease to diagnose, especially in its early stages. In general, the medical history alone can offer a doctor several clues that, when pieced together, point to a diagnosis of AS:

• The patient is a male between 16 and 35
• Back pain and stiffness developed gradually
• Symptoms have been present continually for more than three months
• The patient has back stiffness on waking up in the morning
• Exercise helps to relieve the stiffness and pain

• The doctor will assess the flexibility of a patient's spine — asking him to bend over to touch his toes, for example. The doctor may also press on the patient's sacroiliac joints to see if they are tender and measure his lung function to see if the patient has trouble inhaling completely.
• One way to distinguish between a ruptured disc and early ankylosing spondylitis is that while disc pain is improved with rest, the pain of AS usually gets worse with rest and better with movement. Tenderness where a tendon attaches to a bone — a sharp pain in the shoulders, buttocks, back of the knees or the heel — can be a sign of early-stage ankylosing spondylitis.

• Testing the patient's blood for the presence of the HLA-B27 marker can help confirm a diagnosis of AS or help rule out similar diseases like rheumatoid arthritis or lupus. But otherwise, diagnostic tests are not very useful in AS.

• These can provide a definitive diagnosis of AS, but signs of the disease usually don't show up on an X-ray until about five years after the disease begins.
• The first joints to show signs of ankylosing spondylitis are usually the sacroiliac joints, which appear fuzzy on X-rays because their surfaces have been eroded by inflammation.

• Someone recently diagnosed with AS should feel reasonably upbeat. Chances are you've been diagnosed early in the course of the disease. Today's treatments — primarily exercise and the use of non-steroidal anti-inflammatory drugs — can almost always prevent AS from progressing to the point of irreversible spinal rigidity. These treatments also do a good job of alleviating pain and stiffness and enable most people with ankylosing spondylitis to remain active and lead normal, fulfilling lives.Most people with AS lead normal lives, but a take-charge approach emphasizing exercise is absolutely essential for success.

•  Regular activity enables AS patients to maintain a limber spine and prevent spinal deformity. Daily stretching exercises for the spine are especially recommended.
• Swimming may be the best overall exercise for AS patients, since it stretches the back but doesn't stress it the way running or other weight-bearing exercises do.
• Patients suffering from AS must also maintain as straight a spine as possible, by practicing good posture when sitting or standing and by sleeping on a firm mattress.

• Regular use of NSAIDs is also important in treating AS — mainly because of its effect on exercise. These anti-inflammatory drugs ease pain and stiffness enough to allow patients to engage in an active exercise program, which is critical to preventing the disease from worsening.

• Ankylosing spondylitis can be traced to antiquity. In 1912, archaeologists unearthed an Egyptian mummy from about 3,000 BCE, which showed signs of severe AS. The mummy's spine was described as "a rigid block of stone" extending from its base to the neck.
• In studies of people with AS, the disease levelled off in almost all of them, but as many as 40 per cent had restricted joint motion of the spine. Also, in the vast majority of AS sufferers, breathing ability was impaired.