Archive for May, 2009
Sunday, May 31st, 2009
Various treatments can help reduce the pain and stiffness associated with ankylosing spondylitis (AS). For example, exercise and movement help maintain the flexibility of the spine. Swimming is a preferred exercise for AS patients, according to the American Academy of Orthopaedic Surgeons.
The earlier treatment begins, the more effective it is likely to be. It is important that patients seek medical care before AS may cause irreversible damage to the joints.
Treatments used for AS include:
* Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help relieve inflammation, pain and stiffness.
* Disease-modifying antirheumatic drugs (DMARDs). These drugs are used to treat inflamed joints and other tissues. Potential side effects include stomach pain and increased risk of infections.
* Corticosteroids. These medications may suppress inflammation and slow joint damage in advanced cases of ankylosing spondylitis. These drugs are usually taken orally but can also be injected. They should be taken for only a short time under close supervision of a physician, as potential side effects of long-term use include osteoporosis, fractures and diabetes.
* Tumor necrosis factor (TNF) inhibitors. Originally used to treat rheumatoid arthritis, these drugs, a subgroup of biologic response modifiers (BRMs), may decrease inflammation, pain and stiffness in people with AS. Potential risks of TNF inhibitors include serious infections.
Patients frequently will also undergo physical therapy and rehabilitation. This can help improve physical strength and increase flexibility, which may lessen the pain associated with AS. Patients may learn range-of-motion and stretching exercises, which can help increase the flexibility of joints. They may also learn breathing exercises to help them sustain lung capacity, which can be damaged by AS.
Therapeutic use of water (hydrotherapy) and heat (thermotherapy) may also help.
Patients may learn proper sleep and walking positions to help them maintain proper posture and ergonomics. Using a proper chair, bed, mattress and pillow also help in maintaining normal ergonomics. Abdominal and back exercises can also help these efforts. When AS progresses, the upper body tends to stoop forward, but these exercises can help prevent that from occurring. Patients who have difficulty performing daily tasks may be referred to occupational therapy.
Hip replacement surgery involves inserting a plastic cup and metal ball into an enlarged hip socket.AS does not usually require surgery. However, an operation may be recommended for patients with severe pain or joint damage. Depending on the area affected, possible options may include spinal osteotomy, vertebral column resection, hip replacement or knee replacement, according to the American Academy of Orthopaedic Surgeons.
Most patients with ankylosing spondylitis remain employable and continue to function well in society. Education about the disease is essential in the treatment of AS.
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Saturday, May 30th, 2009
In diagnosing ankylosing spondylitis (AS), a physician is likely to begin by reviewing the patient’s medical history and performing a physical examination. X-rays may be taken to CAT scan is an imaging test used in pain diagnosis, to guide treatment and to monitor for relapse.see whether or not the sacroiliac joint is inflamed. In severe and longstanding cases of AS, calcification of ligaments in the back occurs. On x-rays, this gives the back a “bamboo-spine” appearance. In some other cases, a bone scan or CAT scan (computed axial tomography) is used to view these internal features.
The physician may take a blood sample to check for the presence of genes such as HLA-B27, which is present in about 90 percent of patients with ankylosing spondylitis. Blood tests may also be used to check for elevated sedimentation rate – a measurement of the speed at which red blood cells settle to the bottom of a tube of blood in one hour – which indicates inflammation.
Blood testing can also reveal the presence of anemia, a condition in which there is a lack of healthy red blood cells to carry adequate oxygen to tissues. The chronic inflammation of AS may cause anemia.
Other tests may be ordered if a patient has symptoms suggesting a disorder related to AS, such as a colonoscopy for inflammatory bowel disease.
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Friday, May 29th, 2009
The most common symptom of ankylosing spondylitis (AS) is low back pain and stiffness due to inflammation. This usually begins around the sacroiliac joints, where the lower spine joins the pelvis. It may take days or weeks to develop.
Inactivity tends to make symptoms worse, and many patients experience back pain in the middle of the night and may feel stiff in the morning. Movement and exercise tend to reduce symptoms.
As the disease progresses, it may cause inflammation in the upper spine, chest and neck. As the inflammation associated with AS persists, new bone forms during the healing process, causing the vertebrae to grow together. This results in the formation of bony outgrowths (syndesmophytes) that cause the spine to become stiff and inflexible. This process can also occur in the rib cage, restricting lung capacity and function.
Other joints that may become inflamed include the hips, shoulder, knees or ankles. In some cases, the heels are affected and the patient may find it uncomfortable to stand or walk on hard surfaces. In other cases, inflammation can reach the heart, increasing the risk of heart problems. The severity of symptoms and level of disability triggered by AS vary from person to person.
Symptoms associated with more advanced cases of AS include:
* Restricted expansion of the chest and chest pain
* Chronic stooping
* Stiff, inflexible spine
* Loss of lateral flexion (bending sideways)
* Tenderness over the sacroiliac joint
* Fatigue
* Loss of appetite
* Unexplained weight loss
* Bowel inflammation
* Inflammation of the iris (iritis) and eye pain
Patients may have other symptoms if the heart or lungs are involved.
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Thursday, May 28th, 2009
The exact cause of ankylosing spondylitis (AS) remains unknown. However, genetics may be a factor, because a gene called HLA-B27 occurs in more than 90 percent of patients with the disease, according to the Arthritis Foundation. However, not everybody with HLA-B27 develops ankylosing spondylitis. People with HLA-B27 who have no relative with AS have only a 2 percent chance of developing the disease, whereas people with the gene who do have a parent or sibling with AS have a 20 percent chance of developing AS.
In 2007 two other gene variants were linked to AS: IL23R and ARTS1. People who have both of these and HLA-B27 may have a 25 percent chance of developing AS.
AS is believed to be an autoimmune disease, meaning that the patient’s immune system is hyperactive and mistakenly attacks the body’s own tissues. Other examples of autoimmune diseases include rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease.
AS primarily affects boys and men between the ages of 16 and 35. It is less common in women, although it may develop during pregnancy. It is also normally less severe in women, making it harder to diagnose. AS is more common in American Indians than in other racial and ethnic groups, according to the American College of Rheumatology.
About 5 percent of cases develop in children. AS is more likely to appear in boys than girls. Symptoms in children usually begin in the hips, knees, heels or big toes before progressing to the spine.
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Wednesday, May 27th, 2009
Ankylosing spondylitis (AS) is type of chronic arthritis that primarily affects the spine. The joints between the vertebrae of the spine and ligaments that allow the back to move become inflamed, sometimes leading to the joints and bones fusing together. This inflammation often leads to stiffness of the back and hips.
The name of the disease describes its destructive nature. “Ankylosing” means stiff or rigid, “spondyl” refers to the spine, and “itis” means inflammation. AS belongs to a family of diseases known as spondylarthropathies that attack the spine. These diseases include psoriatic arthritis, Reiter’s syndrome (a form of reactive arthritis, sparked by infection) and enteropathic arthritis (arthritis related to digestive disorders such as inflammatory bowel disease or celiac disease).
While AS progresses, it can also cause inflammation of other organs in the body, including the eyes, lungs and heart valves. Anemia (reduced number of red blood cells) is also associated with the chronic inflammation of ankylosing spondylitis.
The impact of AS varies widely from individual to individual. Some patients experience episodes of back pain that come and go, whereas others have chronic symptoms that worsen and cause severe joint and back stiffness, loss of motion and deformity.
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Tuesday, May 26th, 2009
Ankylosing spondylitis (AS) is a type of arthritis that primarily Anatomy of the spine includes the cervical spine, thoracic spine, lumbar spine and sacral region.affects the spine. It inflames the joints and ligaments that normally allow the back to move. As the disease progresses it can affect other joints, such as those between the ribs and spine and those of the shoulders, hips, knees and feet. It can also cause inflammation in the eyes, lungs and heart valves.
Patients with AS experience chronic pain and stiffness in the lower back. Inactivity tends to make symptoms worse. Many patients experience back pain in the middle of the night and may feel stiff in the morning.
Several genes have been linked to AS, but its exact cause remains unknown. It is believed to be an autoimmune disease, meaning the patient’s immune system is hyperactive and attacks the body’s own tissues.
Treatments including medications and exercise can help reduce the pain and stiffness. The earlier treatment for AS begins, the more effective it is likely to be.
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Monday, May 25th, 2009
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about disease-modifying antirheumatic drugs (DMARDs):
1. Are DMARDs the best choice for me and my condition?
2. What side effects might I have?
3. How likely am I to experience serious side effects?
4. What alternative treatments are available if I choose not to take DMARDs? Will my condition worsen if I do not take DMARDs?
5. Can my child’s condition be treated with DMARDs?
6. Can I drink alcohol while I’m using these medications?
7. Can this DMARD interact with birth control pills or other medications?
8. How long after childbirth should I wait to resume treatment with DMARDs?
9. Should I avoid exposure to the sun while using DMARDs? Is it OK if I spend time outside after applying a sunscreen?
10. Should I receive vaccinations while taking DMARDs?
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Wednesday, May 20th, 2009
Disease-modifying antirheumatic drugs (DMARDs) may harm fetal development. Consequently, sexually active men and women using DMARDs should use effective means of contraception during every sexual encounter. In most cases, women who are pregnant or breastfeeding or who may become pregnant are advised not to take DMARDs.
In addition, it is important to note that some DMARDs may decrease the effect of birth control pills (oral contraceptives). Patients using these contraceptives are advised to ask their physician about alternate methods of birth control.
DMARDs are acceptable for children in certain circumstances, such as juvenile rheumatoid arthritis or organ transplantation, but children are monitored closely for possible side effects. Occasionally, lower doses of DMARDs may be required for elderly individuals. However, they generally are at no greater risk for side effects than younger adults.
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Monday, May 18th, 2009
Symptoms of overdose can be similar to the medication’s side effects but are usually more severe. Patients exhibiting any of these symptoms should contact their physician immediately:
* Nausea and vomiting
* Tremor or seizures
* Headache
* Drowsiness or dizziness
* Visual changes
* Swollen ankles
* Shock
* Hair loss
* Anemia (too few red blood cells)
* Dermatitis (inflammation of the skin)
* Abdominal pain
* Jaundice
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Sunday, May 17th, 2009
Many drug interactions with disease-modifying antirheumatic drugs (DMARDs) exist. Patients are encouraged to consult a physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.
Patients are advised to discuss with a physician whether vaccines should be administered when taking DMARDs. In addition, several DMARDs may cause an increase in sun sensitivity. Eating grapefruit or drinking the juice should be avoided before or after taking the DMARD cyclosporine. Recent research also suggests that pomegranate juice may affect some medications like grapefruit juice does. Use of antacids at the same time as sulfasalazine is not recommended.
Some types of medication may reduce the effectiveness or cause side effects in patients taking DMARDs, depending on the situation of the patient. They include:
* Antibiotics, antifungals and antivirals
* Anticonvulsants
* Birth control pills (oral contraceptives)
* Heart medications
* NSAIDs, including aspirin, ibuprofen and naproxen
* Tuberculosis drugs
Blood pressure, kidney function and liver function are often monitored regularly to protect against side effects. Long-term DMARD therapy in children and pregnant women is usually discouraged. In addition, DMARDs may not be appropriate for patients who have recently undergone radiation therapy.
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