Ankylosing Spondylothesis

Fatigue is another common complaint, occurring in approximately 65% of patients with AS.

Fatigue is another common complaint, occurring in approximately 65% of patients with AS.

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Other clinical manifestations include peripheral arthritis, enthesitis, and extra-articular organ involvement.

AS is the prototype of the spondyloarthropathies, a family of related disorders that also includes reactive arthritis (Re A), psoriatic arthritis (Ps A), spondyloarthropathy associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthropathy (USp A), and, possibly, Whipple disease and Behçet disease (see the image below).

Ankylosing spondylitis (AS), a spondyloarthropathy, is a chronic, multisystem inflammatory disorder involving primarily the sacroiliac (SI) joints and the axial skeleton. The outcome in patients with a spondyloarthropathy, including AS, is generally good compared with that in patients with a disease such as rheumatoid arthritis.

Non-radiographic axial spondyloarthropathy is a term used to describe patients with predominantly axial features and includes patients with clinical features of AS but with normal plain radiographs of the sacroiliac joints and spin.

The spondyloarthropathies are linked by common genetics (the human leukocyte antigen [HLA] class-I gene AS is classified as a spondyloarthropathy.

The disorder is often found in association with other spondyloarthropathies, including Re A, Ps A, ulcerative colitis (UC), and Crohn disease.SI joint involvement is followed by involvement of the discovertebral, apophyseal, costovertebral, and costotransverse joints and the paravertebral ligaments.Early lesions include subchondral granulation tissue that erodes the joint and is replaced gradually by fibrocartilage and then ossification.Early diagnosis is important because early medical and physical therapy may improve functional outcome.As with any chronic disease, patient education is vital to familiarize the patient with the symptoms, course, and treatment of the disease.Peripheral joints and entheses and certain extra-articular organs, including the eyes, skin, and cardiovascular system, may be involved to a lesser degree. Cytokines, particularly tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β), are also important in the inflammatory process by leading to fibrosis and ossification at sites of enthesitis.The initial presentation of AS generally relates to the SI joints; involvement of the SI joints is required to establish the diagnosis.Patients often have a family history of either AS or another spondyloarthropathy.The diagnosis of AS is generally made by combining clinical criteria of inflammatory back pain and enthesitis or arthritis with radiological findings.Power Doppler ultrasonography can be used to document active enthesitis.In addition, this technology may be useful in the assessment of changes in inflammatory activity at entheses during the institution of new therapies.