My Son Has A Stiff Back When He Gets Up in the Morning, Is It Ankylosing Spondylitis?

Ankylosing Spondylitis is one of the moregoals consist of relieving pain and stiffness as well
common forms of arthritis affecting about 0.5%as maintaining function.A comprehensive program
of the population. It affects men more often thanconsists of a combination of anti-inflammatory
women in a ratio of about 2.4-5:1. The disease ismedicines to help with symptoms as well as
categorized as a "spondyloarthropathy"... a type ofdisease-modifying therapy to slow down the rate
arthritis that preferentially affects the spine. Itof progression. Examples of anti-inflammatory
usually starts in the sacroiliac joints- the joints thatdrugs are drugs such as ibuprofen (Motrin),
join the pelvis to the low back- and spreadsnaproxen (Naprosys), nabumetone (Relafen),
upwards to involve the rest of the spine. Peaketodolac (Lodine), meloxicam (Mobic), and
age of onset is between 15 and 30celecoxib (Celebrex). Disease-modifying drugs that
years.Typically, a patient will complain of stiffnessare used extensively for this condition are
in the low back or neck or both that is worsesulfasalazine (Azulfidine) and methotrexate. Biologic
with rest and better with activity. Often, a youngtherapies like etanercept (Enbrel), adalimumab
person will pursue sports as a way to relieve the(Humnira), and infliximab (Remcade) are
pain they have! Stiffness during the day afterconsidered important for inducing remission. A solid
inactivity is also common. Other joints affectedprogram of physical therapy to help with range of
include the hip, knee, wrists, shoulders, elbows,motion is also mandatory.For patients with
and ankles. Fatigue is a very common symptom.suspected eye disease, close supervision by an
Occasionally low grade fever, appetite loss, andexperienced ophthalmologist is also
weight loss may be seen.Patients will sometimesrecommended.Patients with far-advanced disease
present with the extra-articular (outside of themay suffer complications including compression of
joint) symptoms. Examples include inflammation ofthe spinal cord (cauda equina syndrome), and
the eye, lungs, and rarely, the heart. The mostfractures of the neck. In particular, care should be
common extra-articular symptom is eyeexercised in preparing patients with AS for
inflammation which occurs in about 40% ofsurgery. Intubation (placing a breathing tube into
patients and must be diagnosed and treatedthe airways) for general anesthesia carries the
aggressively. Blindness is a dreadedrisk of inadvertent spine fracture.Surgery is
complication.The physical exam will show limitationreserved for far advanced cases that have not
of range of motion in the low back. Chestresponded to medical therapy.The clinical course
expansion is also restricted since many patientsand prognosis is highly variable and also highly
with AS will have limited ability to expand theirdependent on the rapidity of diagnosis and the
lungs due to involvement of the thoraciceffectiveness of therapy.Dr. Wei (pronounced
spine.Occasionally, women with AS will have more"way") is a board-certified rheumatologist and
symptoms in the neck than the lowClinical Director of the nationally respected
back.Laboratory testing will show abnormalitiesArthritis and Osteoporosis Center of Maryland. He
that indicate the presence of inflammation.is a Clinical Assistant Professor of Medicine at the
Patients with AS will also have the genetic markerUniversity of Maryland School of Medicine and has
HLA B27 in about 90% of cases.Imaging studiesserved as a consultant to the Arthritis Branch of
such as magnetic resonance imaging will show thethe National Institutes of Health. He is a Fellow of
presence of inflammation in the sacroiliac joints.the American College of Rheumatology and the
Inflammation of the tendon insertions at differentAmerican College of Physicians.
affected joints will also be evident.Treatment