Tuesday, February 24, 2015

Ankylosing Spondylitis Myths

The following are myths that you may come across in your search for a diagnosis of Ankylosing Spondylitis (AS):
  • Only those with the HLA-B27 Gene can get AS - X Wrong! You can still have AS without this gene. In fact 5-20% of people with AS do not have this gene.
  • Only men can get AS - X Wrong! Yes, AS is more prominent in men. But women get it too! This blogger is one of them. If your GP or Rheumatologist tells you you can't have AS because you are a woman, walk right out of there and see someone else! There are plenty of us ladies in the online support groups who will attest to this. One statistic says one in four of those with AS are women. 
  • If you don't show inflammation in your blood (CRP & ESR) you don't have AS - X Wrong! 30-50% of people with AS don't have high inflammation CRP and ESR markers in their blood. 

Monday, February 16, 2015

Symptoms of Ankylosing Spondylitis

The symptoms of Ankylosing Spondylitis (AS) can vary in different people. These symptoms are also common to other ailments, including other Autoimmune diseases. So alone these symptoms can not be used to diagnose AS:

  • Back pain - lasting more then 3 months
  • Stiffness and pain in lower back, hips, tail bone or bottom
  • Stiffness in morning, or after a period of in-activity
  • Fatigue
  • Pain in other non spine joints and muscles
  • Bowel inflammation
  • Inflammation of the eye (uveitis)
  • Skin Problems such as psoriases
  • Pain in the heel or under the foot

For more information on diagnosing AS, please see here.

Diagnosing Ankylosing Spondylitis

Ankylosing Spondylitis (AS) can take a long time to develop. The symptoms are the same or similar to generic back pain and other autoimmune diseases. So for a diagnosis the Rheumatologist needs to distinguish it from other possibilities by looking for specific AS only characteristics.

Along with showing general symptoms of AS, these characteristics below, combined, are generally used in diagnosis:

  • Grade 2 bilateral sacroiliitis OR, Grade 3 or higher unilateral sacroiliitis via Xray - in layman's term this means the signs of damage caused by inflammation of sacral joints (sacroiliitis) seen in both of the sacral joints, OR a definite vision of damage or complete fusion, seen in at least one sacral joint.
  • HLA-B27 gene or family history of AS - 80-95% of people with AS have the HLA-B27 gene. Note having the HLA-B27 gene doesn't meant you will have or get AS. Only 9% of the population have this gene, and only 5% of those develop AS. You can have AS without this gene, or any previous history.
  • High levels of C-reactive protein (CRP) and raised erythrocyte sedimentation rates (ESR) - determined by a blood test, these levels indicate inflammation. Not everyone who has AS actually show high levels of inflammation in their blood. This is only seen in 50-70% of people with AS.

If you have any suspicions that you may have AS, please speak to your General Practitioner to get a referral to a Rheumatologist to run the necessary tests.

A description of the sacroiliitis gradings can be found here:

What is Ankylosing Spondylitis (AS)?

Ankylosing Spondylitis (AS) is an inflammatory arthritis, autoimmune condition that primarily effects the spine and pelvic joints, causing fusion.

Inflammation is part of the immune system function of our bodies used to fight diseases. In autoimmune conditions the body is a bit confused, and is actually fighting itself. :(

The inflammation seen in AS occurs in the part where the tendons and ligaments join the bone.  This type of inflammation is called enthesitis.

When the continued inflammation of the joining point, has actually damaged the bone, the immune system rebuilds it. Unfortunately this leads to bony growths, called syndesmophytes. That then cause further issues for the tendons and ligaments by stiffening and weakening them.  Overtime this calcification can lead to a complete fusion of the joint, particularly occurring in the spine joints.

That is why reducing/stopping the inflammation is the Dr's first priority when managing a patient's AS.

For more on AS Symptoms, click here.