BAMBOO SPINE-ANKYLOSING SPONDYLITIS

Hello  Readers,

Now I am with the topic known as...

                     ANKYLOSING SPONDYLITIS
          
                                   OR

                        
                           BAMBOO SPINE
                              

                                OR
                                   
                     BECHTEREWS DISEASE

Splitting the words get it meaning........
  
ANKYLOSING-Stiffness or united 
SPONDYLITIS- Inflammation of the spine

PREVALENCE in India is 1 million per year.

Definition of AS- Its a type of inflammatory, autoimmune arthritis affecting joints of the spine and sacroiliac joints are also involved.  There is also systemic illness 

The HALLMARK  feature of AS is arthritis in the sacroiliac joint

AGE GROUP mainly involved is 17 to 45 years.

CAUSES 

It is a chronic autoimmune disease with an unknown cause.
In many patients, there is evidence of an antigen HLAB27(HUMAN LUEKOCYTE ANTIGEN).

The gene unleashes immune system and attack common bacteria of body and set off the AS symptoms. The antigen is present in 9 out of 10 people and is triggered by environmental factors.


MEN are more affected than WOMEN

SYMPTOMS

The onset of symptoms is slow that is over several months or years. There is remissions and exacerbations.

- Back pain and stiffness 

• The feature of pain is it gets better with exercise but does not improve or get worse with rest.
• It is worse in the morning and at night. The patient may complain of waking up due to pain regularly.
• The patient may feel pain and discomfort in buttocks.
• There may be present symptoms of arthritis in the knee and hip. The symptoms are a pain, tenderness, swelling, warmth on examination in the knee and hips.

-Enthesitis- Painful inflammation where the bone is joint to a tendon or a ligament (a bond of tissue that connects bone to bone).

Common sites of enthesitis 

• at top of shine bone
• behind heel
  
• under heel
• where ribs join the breast bone

 

At worse, if ribs are affected there is difficulty in chest expansion which leads to difficulty in breathing. Breathing leads in pain in the chest.

-Fatigue is a common symptom of untreated AS. Feeling of tiredness and lack of energy is experienced. 

Mostly upper spine is affected and it progresses to rib and neck.

Bone fuses due to inflammation and stiffness which looks like bamboo appearance in the spine, also known as BAMBOO SPINE.

Heels are affected making it uncomfortable to stand or walk on a hard surface.

SYSTEMIC INVOLVEMENT includes fever, loss of appetite, fatigue, inflammation in the lungs, heart, and EYES.

DIAGNOSIS

The rheumatologist is a physician who diagnoses the AS .

Symptoms are a hallmark for diagnosis. The physician take medical and family history of patient.

Blood test including HLAB27 antigen and Erythrocyte sedimentation rate are done.

X-RAY shows the deformity of the spine and sacroiliac joint.

MRI scans show inflammation in the sacrum.

CT scans are done to check whether organs and systemic involvement is present. 

Physical therapist check for chest expansion.

Physical therapist check for spinal flexibility with measurement of spinal movements (goniometry).

Flesche test -To asses the severity of spinal deformity in flexion.

Modified Scobers test-To asses the lumbar flexion.

Lumbar spine side flexion - To asses the side flexion.

Tragus to wall test-To asses the cervical mobility of an individual.

COMPLICATIONS

• Eye problems
• Reduces flexibility of the spine
• Osteoporosis
• Gastrointestinal disorders
• Breathing difficulty
• Social employment problems

TREATMENT

The goal of treatment is to relieve pain and stiffness and prevent complications and prevention of spinal deformity.

MEDICAL MANAGEMENT 

-NSAIDs (nonsteroidal anti-inflammatory drug) including naproxen, diclofenac, aspirin.

-INDOMETHACIN including ibuprofen. The medicine help to relieve pain and stiffness

-TNF blockers (tumor necrotic factor) including adalimumab, etanercept.  

-IL-17& inhibitor play role in body defense against infection.

-CORTICOSTEROIDS including dexamethasone or prednisolone.

- METHOTREXATE-The medication use in cancer and AS too.

-SULFASALASINE- use for swelled joints and also for intestinal lesion and inflammatory bowel disease.

-DMARDS(disease-modifying anti-rheumatic drugs) including methotrexate, sulfasalazine, cyclosporines.

Not all drugs are used for a patient rheumatologist prescribe them according to patient condition.

PROGNOSIS depends on physical therapy and medical management. It is noncurable but can be modifiable.

PHYSICAL THERAPY FOR AS

-Breathing exercises and chest expansion exercises are prescribed.

-Resisted exercise for pulmonary inspiratory muscle.

-Spinal EXTENSION exercise is a key  component for pt management.

-Posture correction is taught to the patient's work and at rest.

-Range of motion exersice for knees and hips to prevent flexion deformity and contractures.

-Periodic rest periods with avoidance of fatigue

-Bracing and corseting are prescribed and should be used while resting and exercise.

-Both active and passive stretching of the flexors group of muscles is done.

-Active and passive exercises for spine i.e.., spinal extension and spine side flexion is taught.

-Cervical, thoracic and lumbar flexibility exercise is done.

-Aerobic exercises are taught for increasing cardiovascular capacity.

HYDROTHERAPY is also a good treatment option for heavy patients as buoyancy for water helps to treat heavy patients.

GROUP THERAPY IS USEFUL WHICH ENCOURAGE THE PATIENT TO PERFORM EXERCISE.

PROPER sleeping posture on a solid ,flatbed without a pillow is recommended

Don't let the spine-convert bamboo. AS is not curable but it is modifiable.

STAY HEALTHY.....STAY CONNECTED.....