Mr. Leclair is a 30-year-old computer programmer.  During the past few years, he has gradually experienced aching in his lower back and tailbone area.  His pain, which is worse at night, wakes him up frequently, and when he wakes up in the morning, he always has a very stiff back, which usually improves as the day progresses.  His father also has similar symptoms for years.

 

‘Ankylosing’ (rigidity) ‘spondyl’ (spine) ‘it is’ (inflammation) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joint.  When spinal ligaments and tendons become inflamed, not only do they cause pain, but they also ossify (turn into bone) and form bone spurs on our vertebrae.  In severe cases, the joints and bones may grow and fuse together, transforming our flexible spine into a rigid column and making movement difficult.

The main symptom of AS is resting back pain.  Back pain develops slowly and is worse when moving after being still for a period of time and improve with activity.  However, AS can also affect the knees, hips, shoulders, heels, and other small joints.  Twenty percent of patients with AS also show involvement in their hips and shoulders.  If you have AS, you may also experience pain in the soles of your feet due to inflammation of connective tissue (plantar fasciitis), of the heel tendon (Achilles tendonitis), or due to heel spurs.  Because AS is a systemic disease, meaning it can affect other organs, such as the eyes, heart, and lungs, it can also be associated with inflammatory bowel disease, psoriasis and uveitis (inflammation of the uvea).

The actual cause of AS is unknown.  However, even though AS can strike any age, gender or race, Caucasian males between the ages of sixteen and thirty seem to be at greatest risk.  Women have milder symptoms and are less susceptible.  Genes and heredity seem to play an important role in developing AS, particularly the HLA-B27 gene.  Ninety percent of people with AS possess the HLA-B27 gene.  However, having it alone does not necessarily mean you’ll have AS.  Approximately eight percent of healthy Caucasian Americans and three percent of healthy African Americans carry this gene.

NSAIDs (non-steroidal anti-inflammatory drugs) such as Naprosyn, Indomethacin usually are quite helpful, but adequate doses must be used. DMARDs (disease modifying anti-rheumatic drugs) such as Methotrexate have not been proven to be very effective in the treatment of AS.  Anti-tumor necrosis factor (anti-TNF) biologics such as Enbrel, Humira, Remicade and Cimza are very effectiveness in treating AS. Cosentyx (secukinumab), blocking IL-17, is also approved for the treatment of AS. For most patients, AS’s long-term outlook is very good.  More than ninety percent of patients are able to cope with the demands of normal daily living very well and can expect to have a normal life span.

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