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Ankylosing Spondylitis

It is an inflammatory disease that, over time, can cause some of the small bones in spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. It is more common in young to middle aged males.

The etiology of AS is unknown, but in many cases there seems to be a link with a particular gene known as HLA-B27
Clinical manifestations:
1- Constitutional symptoms:
•Loss of appetite, weight loss
•Fatigue, decreased energy
2- Axial spine:
•Stiffness and pain in the lower back, buttocks, and hips upon waking in the morning or after a period of inactivity.
•Back pain  exacerbated by rest and relieved by movement and exercise and improved with non-steroidal anti-inflammatory drugs.
•Morning stiffness more than 30 minutes.
•Difficulty bending the spine
•Alternating buttock pain
3-Enthesitis:
•Pain in the heels and soles of the feet
4- arthritis
5-Ocular manifestations

•Eye swelling, redness, and pain
•Sensitivity to light (photophobia).
6-Cardiac manifestations
•Aortic regurgitation.
•Heart block (first degree heart block)
7-Pulmonary manifestations:
•Difficulty taking a deep breath (because expanding the chest is difficult and painful)
Apical pulmonary fibrosis.

Complications:
1. Reduced flexibility
2. Joint damage
3. Iritis
4. Osteoporosis and spinal fractures
5. Cardiovascular disease
6. Cauda equina syndrome
7. Amyloidosis


 Treatments:
Medications help some people. But staying active is one of the keys to managing AS.
1-Patient education and life style modifications.
2-Exercise.
2-Physical therapy.
3-Medication
     Nonsteroidal anti-inflammatory drugs (NSAIDs)
    Conventional synthetic DMARDs
    Biologic DMARD

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