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the 1 last update 2020/07/07
|Other names||Bekhterev''s disease, morbus Bechterew, Bekhterev–Strümpell–Marie disease, Marie''s disease|
|A 6th-century skeleton showing fused vertebrae, a sign of severe ankylosing spondylitis|
|Symptoms||Back pain, joint stiffness|
|Usual onset||Young adulthood|
|Diagnostic method||Symptom based, medical imaging, blood tests|
|Treatment||Medication, exercise, and surgery|
|Medication||NSAIDs, steroids, DMARDs|
|Frequency||0.1 to 1.8%|
Ankylosing spondylitis (AS) is a type of arthritis in which there is a long-term inflammation of the joints of the spine. Typically the joints where the spine joins the pelvis are also affected. Occasionally other joints such as the shoulders or hips are involved. Eye and bowel problems may also occur. Back pain is a characteristic symptom of AS, and it often comes and goes. Stiffness of the affected joints generally worsens over time.
Arthritis Curehow to Arthritis Cure for Although the cause of ankylosing spondylitis is unknown, it is believed to involve a combination of genetic and environmental factors. More than 90% of those affected in the UK have a specific human leukocyte antigen known as the HLA-B27 antigen. The underlying mechanism is believed to be autoimmune or autoinflammatory. Diagnosis is typically based on the symptoms with support from medical imaging and blood tests. AS is a type of seronegative spondyloarthropathy, meaning that tests show no presence of rheumatoid factor (RF) antibodies. It is also within a broader category known as axial spondyloarthritis.
There is no cure for ankylosing spondylitis. Treatments may improve symptoms and prevent worsening. This may include medication, exercise, and surgery. Medications used include NSAIDs, steroids, DMARDs such as sulfasalazine, and biologic agents such as TNF inhibitors.
Between 0.1% and 1.8% of people are affected. Onset is typically in young adults. Males are more often affected than females. The condition was first fully described in the late 1600s by Bernard Connor, but skeletons with ankylosing spondylitis are found in Egyptian mummies. The word is from Greek ankylos meaning to unite or grow together, spondylos meaning vertebra, and -itis meaning inflammation.
Ankylosing spondylitis (AS) is a systemic rheumatic disease, meaning it affects the entire body. 1–2% of individuals with the HLA-B27 genotype develop the disease. Approximately 90% of people with AS express the HLA-B27 genotype, meaning there is a strong genetic association. Tumor necrosis factor-alpha (TNF α) and IL-1 are also implicated in ankylosing spondylitis. Autoantibodies specific for AS have not been identified. Anti-neutrophil cytoplasmic antibodies (ANCAs) are associated with AS, but do not correlate with disease severity.
Single nucleotide polymorphism (SNP) A/G variant rs10440635 close to the PTGER4 gene on human chromosome 5 has been associated with an increased number of cases of ankylosing spondylitis in a population recruited from the United Kingdom, Australia, and Canada. The PTGER4 gene codes for the prostaglandin EP4 receptor (EP4), one of four receptors for prostaglandin E2. Activation of EP4 promotes bone remodeling and deposition (see EP4, bone) and EP4 is highly expressed at vertebral column sites involved in ankylosing spondylitis. These findings suggest that excessive EP4 activation contributes to pathological bone remodeling and deposition in ankylosing spondylitis and that the A/G variant rs10440635a of PTGER4 predisposes to this disease, possibly by influencing EP4''s testArthritis Curehow to Arthritis Cure for 
Arthritis Curehow to Arthritis Cure for The Schober''s quality of life. Complete fusion of the spine can lead to a reduced range of motion and increased pain, as well as total joint destruction which could lead to a joint replacement.
Osteoporosis is common in ankylosing spondylitis, both from chronic systemic inflammation and decreased mobility resulting from AS. Over a long-term period, osteopenia or osteoporosis of the AP spine may occur, causing eventual compression fractures and a back "". Hyperkyphosis from ankylosing spondylitis can also lead to impairment in mobility and balance, as well as impaired peripheral vision, which increases the risk of falls which can cause fracture of already-fragile vertebrae. Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays and abnormal bone outgrowths similar to osteophytes affecting the spine. In compression fractures of the vertebrae, paresthesia is a complication due to the inflammation of the tissue surrounding nerves.
Organs commonly affected by AS, other than the axial spine and other joints, are the heart, lungs, eyes, colon, and kidneys. Other complications are aortic regurgitation, Achilles tendinitis, AV node block, and amyloidosis. Owing to lung fibrosis, chest X-rays may show apical fibrosis, while pulmonary function testing may reveal a restrictive lung defect. Very rare complications involve neurologic conditions such as the cauda equina syndrome.
Mortality is increased in people with AS and circulatory disease is the most frequent cause of death. People with AS have an increased risk of 60% for cerebrovascular mortality, and an overall increased risk of 50% for vascular mortality. About one third of those with ankylosing spondylitis have severe disease, which reduces life expectancy.
As increased mortality in ankylosing spondylitis is related to disease severity, factors the 1 last update 2020/07/07 negatively affecting outcomes include: As increased mortality in ankylosing spondylitis is related to disease severity, factors negatively affecting outcomes include:
The hunched position that often results from complete spinal fusion can have an effect on a person''s disease or Marie–Strümpell disease.