Autoimmune ankylosing spondylitis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The immune system provides a surveillance mechanism that protects against potentially harmful invaders such as bacteria, cancers, and so on.
But in situations where the immune system goes awry, immune cells can mistake one's own cells as invaders and attack them. In a sense, it is a biologic equivalent of "friendly fire". This is called autoimmunity (meaning self-immunity).
Genetic factors are largely responsible for the functioning or malfunctioning of the immune system. Certain genes or combination of genes predispose a person to developing an autoimmune disease. Certain environmental triggers turn on the immune system. Examples include sunlight, infections, various drugs, or even pregnancy.
Because autoimmune diseases can affect any organ system in the body, one method of categorizing them is by the body system(s) they attack.
Diagnosis is not easy. The process of diagnosis though is fairly standardized:
• Medical history--Duration and types of symptoms and family history are the most important clues.
• Physical exam--A careful look from head to toe is mandatory.
• Laboratory tests-- These often confirm a physician's suspicions and are very important in making a specific diagnosis. For example, people with lupus or rheumatoid arthritis often have unique autoantibodies in their blood. Autoantibodies are blood proteins manufactured by the immune system and directed against the body's cells.
The diagnosis is not always clear cut and can take time to make. It may take several visits to find out exactly what's wrong and the optimal way to treat it.
Treatment depends on the type of disease as well as the severity of the disease. Treatments have three goals:
• Relief of symptoms--
• Preservation of organ function--
• Targeting immune dysfunction--
Ankylosing spondylitis (AS) is a inflammatory rheumatic disease that primarily affects the spine and sacroiliac joints but which can also cause inflammation of the eyes, lungs, and heart valves. It can be a severe chronic disease that attacks the spine, peripheral joints and other body organs, resulting in severe joint and back stiffness, loss of motion and deformity.
AS is part of the family of diseases that attack the spine called spondylarthropathies. In addition to AS, these diseases include Reiter’s syndrome, some cases of psoriatic arthritis and the arthritis of inflammatory bowel disease.
The cause of AS is not known, but the spondylarthropathies share a common genetic marker, called HLA-B27. In some cases, the disease occurs after experiencing bowel or urinary tract infections.
• AS affects an estimated 129 out of 100,000 people in the United States.
• AS typically strikes adolescents and young adult males.
• The prevalence of AS varies by ethnic group and more common in Asians and Native Americans.
A delay in diagnosis is common because symptoms are often attributed to more common back problems. Loss of flexibility in the lumbar spine is an early sign of AS. Although most symptoms begin in the low back and sacroiliac areas, they may involve the neck and upper back as well. This presentation is more common in women. Arthritis may also occur in the shoulder, hips and feet.
At times, AS may precede the development of inflammatory bowel disease, and some patients have constitutional symptoms such as fever, fatigue, weight loss, anemia, eye inflammation (iritis), and patients with more severe disease may develop heart valve dysfunction. Both cardiologists and opthomologists are important in providing ancillary support in the management of AS.
Laboratory testing may reveal an elevated sedimentation rate or C-reactive protein (markers of inflammation), anemia and a positive HLA-B27 assay.
Early treatment consists of non-steroidal anti-inflammatory medications quickly followed by the addition of disease-modifying anti-rheumatic drugs (DMARDS) such as sulfasalazine or methotrexate. Aggressive use of biologic therapy with anti-TNF agents is then indicated.
Rehabilitation therapies are essential. These include exercises to maintain flexibility and chest expansion. Aerobic exercise is important.
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