Spondylitis is the
name for a specific type of inflammatory arthritis that causes mostly affects
the spine, though other joints may become affected as well. There are several
specific diseases in the spondylitis “family”, including; Ankylosing
spondylitis (AS), undifferentiated spondyloarthopathy (USpA) a condition which
advances over time to AS or another kind of arthritis, juvenile
spondyloarthropathy (JSpA) with onset before the age of 16, psoriatic arthritis
(PsA) which is preceded by psoriasis, and reactive arthritis (ReA) which is
thought to derive as a ‘reaction’ to an infection elsewhere.
The specific causes of spondylitis
is unknown, but there are very strong links to the genetic marker HLA-B27,
found in about 8% of the general population. Though the gene has not proven to
cause spondylitis by itself, it has been found that HLA-B27+ individuals are at
an increased risk to develop the condition. Over 95% of European people with spondylitis
ancestry express HBL-B27, but an environmental ‘trigger’ is typically required
to kick start the condition, like a bacterial infection.
The condition is diagnosed,
typically by a rheumatologist, through a thorough physical exam, including
x-ray, individual medical history, family history, and bloodwork with possible
HLA-B27 screening. There are key points to consider for diagnosis, these
include onset usually under the age of 45, chronic pain for more than 3 months,
pain worsen with mobility, especially at night and early morning, stiffness
tends to ease with physical activity, and a positive pain/stiffness relieving
response no non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The doctor
examines the back, pelvic bones, sacroiliac bones, chest and heels for
tenderness and pain. Also limitation of spinal mobility in all directions may
be assessed as well as chest expansion limitations when breathing.
A cure for spondylitis has not been
found yet, but treatment has drastically increased quality of life through exercise,
physical therapy, medication, and posture changes. Helpful exercises include
water therapy, tai chi, and things as simple as walking. One of the problems
with spondylitis is bone fusion, which doesn’t always happen, but it is highly preferable
to observe good posture and allow fusion in an upright position to avoid further
complications. While pinpointing the causes is still a work in progress in the scientific world, individuals who suffer from spondylitis have a lot of pharmaceutical industry support actively looking for a cure, which is in the patient's best interest.
sources
Ankylosing Spondylitis and Related Diseases Information: Diagnosos, Symptoms, Treatment and More. (2013, January 1). Retrieved November 9, 2014, from http://www.spondylitis.org/about/as_diag.aspx
What is spondylitis? (2013, January 1). Retrieved November 9, 2014, from http://www.spondylitis.org/about/faq.aspx#cause
Great summary of spondylitis! I have some experience in PT working with patients with this condition, and it is nice to gain some more insight about their condition. Before this I didn't know much about the disease other than it was a form of arthritis primarily impacting the spine. I do know that the patients who are diagnosed with spondylitis do suffer a great deal, and as it progresses the pain impedes their day-to-day functioning a lot. PT usually focuses a lot on maintaining mobility in the spine, and keeping postural muscles surrounding the vertebrae strong to support them where they are supposed to be. Thanks for sharing!
ReplyDeleteWhen you mentioned that an environmental trigger is commonly required to activate the condition, it kind of reminded me of AIDS and HIV. Like.. you can have the spondylitis gene ancestry (HBL-B27) and it may or may not become activated depending on the environmental trigger. And with HIV and AIDS, you can have the HIV virus but you probably wouldn't completely notice it until you contract another disease/disorder which is what would REALLY affect you. I don't know if that makes any sense but thank you for the article!
ReplyDeleteI was curious what the HLA-B27 gene may encode to know how it might be connected to the development of arthritis. It appears this is an antigen on white blood cells that is correlated with an increased risk of some autoimmune disorders. If there was any involvement of white blood cells in the pathogenesis of disease, this genetic marker could be tied to spondylitis in a causative way and the involvement of an environmental trigger would make sense in the context of activating a self-reactive immune cell. I'm very curious as to why the spine is affected in this type of arthritis, and why bone fusion occurs. This was not an issue we discussed with other types of arthritis.
ReplyDelete"HLA-B27 Antigen." MedlinePlus. U.S. National Library of Medicine, 5 May 2013. Web. 22 Nov. 2014. .
Hey Mario! Thank you for this interesting post on Spondylitis. I had never heard of this condition before, therefore your discussion helped me better understand the condition. In doing some further reading I found it interesting that some of the types of Spondylitis that you mentioned are highly associated with the occurrence of other conditions that we discussed earlier on in the semester. For example, Enteropathic arthritis is associated with inflammatory bowel disease in the form of either Crohn's disease or ulcerative colitis.
ReplyDeletehttp://www.spondylitis.org/About/FAQ.aspx#whatis
Great post Mario. What I find so interesting about many of the arthritis treatments we have discussed is how many of the treatments seem to involve alternatives to just straight medication. Specifically in spondylitis all of the treatments seem to just involve lifestyle changes. This interests me because it seems to lend credit to some of the alternative medicines/treatments we have discussed in class. I wonder what other benefits lifestyle changes could have in other diseases if they were considered the primary treatment.
ReplyDeleteThis post had great background information on spondylitis from all angles! I was curious about the pharmaceutical industry's current research and found some interesting stuff in the links below. There is currently a phase 2 clinical trial occurring across the country looking at tofacitinib. Tofacitinib is already used as a treatment for RA.
ReplyDeletehttps://www.centerwatch.com/clinical-trials/listings/condition/469/ankylosing-spondylitis
http://en.wikipedia.org/wiki/Tofacitinib