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In-Depth Information
aortitis (in
ammation of the aorta, the largest artery in the body, originating from
heart), and colitis (in
fl
ammation can also lead to
secondary amyloidosis (a process of protein deposition in internal organs), usually
associated with kidney dysfunction.
Laboratory tests have limited use in diagnosing AS. Patients may not have
elevated blood markers of in
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ammation of the large bowel). In
fl
am-
matory symptoms. HLA-B27 is not required for diagnosis, and absence of HLA-
B27 does not rule out the diagnosis of AS. However, in the appropriate clinical
setting, HLA-B27 may suggest the diagnosis.
The modi
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ammation, even if they are actively having in
fl
-
cation of AS. By these criteria, patients need have a characteristic clinical pre-
sentation and characteristic radiographic changes
ed New York criteria have been used for 30 years for the classifi-
in the sacroiliac joints.
In
ammatory back pain, limited motion of lumbar spine and limited chest wall
expansion comprise the clinical components; at least one of these features is
required for classifying a person as having AS by these criteria. Radiographic
changes of the sacroiliac joints will be discussed in the Imaging section.
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3.1.3 Treatment
The goal of the treatment is to control inflammation and pain, reduce new bone
formation, and improve or maintain function. This is achieved through a combi-
nation of medications and non-pharmacologic modalities.
NSAIDs are the
ammation.
If one NSAID is not effective or causes side effects, usually another NSAID from a
different class can be tried. After an adequate trial of NSAIDs, if patients still have
symptoms suggesting active in
first line therapy for pain control and to decrease in
fl
ammation, anti-tumor necrosis factor (anti-TNF)
agents are usually considered as the next step. TNF is a pro-in
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ammatory cytokine.
Anti-TNF agents are effective in decreasing pain, stiffness, fatigue, and joint
swelling in AS, and in improving patient
fl
'
s function. With a tolerable side effect
pro
le, anti-TNF agents are a mainstay treatment for AS. Discovery of the asso-
ciation between AS and the interleukin-23 pathway brings new treatment options.
While these medications have shown effectiveness in controlling active in
fl
am-
mation, whether they can reduce new bone formation in AS remains unclear.
Physical therapy and exercise are essential in the treatment of AS. Patients
usually experience a signi
cant reduction of symptoms after exercise, and it helps
them to maintain function. Stretching exercises, such as yoga, may increase spinal
mobility, and deep-breathing may increase chest wall expansion and prevent the
loss of lung function. Postural training is important and patients should avoid a
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flexed position for a prolonged period of time.
Patients with advanced AS may need corrective surgeries for complications
associated with AS. In patients with severe hip involvement, total hip replacement
often provides pain relief and functional improvement. In patients with complete
fusion of the spine, the risk of spinal fracture is increased; surgical stabilization is
needed if spinal fracture occurs.
