ANKYLOSING SPONDYLITIS (Marie strumpelldisease)

Ankylosing spondylitis is a chronic disease characterised by a progressive inflammatory stiffening of the joints, with a predilection for the joints of the axial skeleton, especially the sacroiliac joints. This is a disease of young adults, more common in males


Sacro-iliac joints are usually the first to get involved; followed by the spine from the lumbar region upwards. The hip, the knee and the manubrio-sternal joints are also involved frequently.

Initially synovitis occurs; followed later, by cartilage destruction and bony erosion. Resultant fibrosis ultimately leads to fibrous, followed by bony ankylosis.

Ossification also occurs in the anterior longitudinal ligament and other ligaments of the spine.

After bony fusion occurs, the pain may subside, leaving the spine permanently stiff (burnt out disease).


  1. Classic presentation:

The patient is a young adult 15-30 years old male, presenting with a gradual onset of pain and stiffness of the lower back. Initially, the stiffness may be noticed only after a period of rest, and improves with movement. Pain tends to be worst at night or early morning, awakening the patient from sleep. He gets better only after he walks about or does some exercises. There may be pain in the heel, pubic symphysis, manubrium sterni and costo-sternal joints. In later stages, kyphotic deformity of spine and deformity of the hips may be prominent features.


  1. Unusual presentations:

Patient may occasionally present with involvement of peripheral joints such as the shoulders, hips and knees. Smaller joints are rarely involved. Sometimes, a patient with ankylosing spondylitis may present with chronic inflammatory bowel disease; the joint symptoms follow.



Stiff spine: There may be a loss of lumbar lordosis.Lumbar spine flexion may be limited.

Pump-handle test: With the patient lying supine, the examiner flexes his hip and knee completely, and forces the affected knee across the chest, so as to bring it close to the opposite shoulder This will cause pain on the affected side.


No laboratory test is diagnostic of AS. In most ethnic groups, HLAB27 is present in 75–90% of patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often, but not always, elevated. Mild anemia may be present.

Patients with severe disease may show an elevated alkaline phosphatase level. Elevated serum IgA levels are common.

Rheumatoid factor, anti-cyclic citrullinated peptide (CCP), and antinuclear antibodies (ANAs) are largely absent




1.Stay active.

Exercise helps lessen pain and improves your posture. It also decreases fatigue. Make sure to get several types of exercise, including:

Aerobic exercise, which can help you breathe easier and boost your mood in addition to reducing pain. Consider low-impact aerobic exercise such as swimming, brisk walking, the elliptical, cycling or dancing.Strength-building exercise, which builds muscle to support your body. Try free weights, resistance bands, or body-weight exercises such as pushups, standing squats, planks or exercises on a fitness ball.

2.Be sure to stretch.

Stretching is important for everyone, and it is particularly beneficial if you have ankylosing spondylitis. Make time for light, gentle stretching — even on days you don’t exercise. A good time for this is right after a warm shower or bath. Stretching at night may help you sleep.

3.Stand up straight.

Posture is important. Practice standing straight in front of a mirror. This will help make good posture a habit, which can reduce ankylosing spondylitis symptoms.

4.Quit smoking.

Smoking is bad for your health in general, but it can make it harder for people with ankylosing spondylitis to breathe.

5.Get plenty of calcium and vitamin D.

Calcium helps build strong bones, while vitamin D helps your body better absorb calcium. The combination of these nutrients can help maintain your bone health, which is very important when you have ankylosing spondylitis.

Find calcium in low-fat dairy products, such as yogurt and cheese, , broccoli, and dark leafy greens, such Find vitamin D in sunlight, eggs, and fish



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