Summary about Disease
Marie-Strümpell disease, now more commonly known as ankylosing spondylitis (AS), is a type of arthritis that primarily affects the spine. It causes inflammation of the vertebrae, which can lead to severe, chronic pain and discomfort. In advanced cases, this inflammation can result in new bone formation (ankylosis) causing the spine to fuse in a fixed, immobile position. It's a chronic, progressive condition, meaning it worsens over time.
Symptoms
Chronic pain and stiffness in the lower back and hips, especially in the morning or after periods of inactivity.
Pain and stiffness in other joints, such as the shoulders, knees, or ribs.
Fatigue.
Eye inflammation (uveitis).
Enthesitis (inflammation where tendons and ligaments attach to bone).
Stooped posture.
Reduced range of motion in the spine.
Difficulty breathing (in severe cases due to chest wall stiffness).
Causes
The exact cause of ankylosing spondylitis is unknown, but it's believed to be a combination of genetic and environmental factors. A gene called HLA-B27 is strongly associated with the disease, but not everyone with the gene develops AS, and some people without the gene develop the condition. Other genes and environmental triggers (such as infections) are also likely involved.
Medicine Used
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Like ibuprofen and naproxen, to reduce pain and inflammation.
DMARDs (Disease-Modifying Antirheumatic Drugs): Such as sulfasalazine and methotrexate, to slow the progression of the disease (more effective for peripheral joint symptoms).
Biologics (TNF inhibitors and IL-17 inhibitors): Like adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, secukinumab, and ixekizumab. These target specific parts of the immune system to reduce inflammation.
Corticosteroids: Such as prednisone, to reduce inflammation (used short-term due to side effects).
Pain relievers: Such as tramadol.
Is Communicable
No, ankylosing spondylitis is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Maintain good posture: Be mindful of posture to prevent spinal deformity.
Regular exercise: Helps maintain flexibility and strength. Physical therapy can be beneficial.
Avoid prolonged inactivity: Move around frequently to prevent stiffness.
Quit smoking: Smoking can worsen AS symptoms.
Proper sleep positioning: Use a firm mattress and avoid sleeping in positions that strain the spine.
Eye care: Report any eye pain, redness, or blurred vision to a doctor immediately.
Healthy lifestyle: Maintain a healthy weight and eat a balanced diet.
How long does an outbreak last?
Ankylosing spondylitis is a chronic condition with varying degrees of disease activity. Instead of outbreaks, people with AS experience periods of flare-ups (increased symptoms) and remissions (decreased symptoms). Flare-ups can last for days, weeks, or even months. The length of flare-ups is variable and depends on individual factors such as treatment adherence, stress levels, and overall health.
How is it diagnosed?
Physical examination: Assessment of posture, range of motion, and reflexes.
Medical history: Review of symptoms and family history.
X-rays: To look for changes in the sacroiliac joints (where the spine connects to the pelvis) and spine.
MRI (Magnetic Resonance Imaging): Provides more detailed images of the spine and sacroiliac joints, useful for detecting early inflammation.
Blood tests: To check for the HLA-B27 gene and markers of inflammation (such as ESR and CRP). Blood tests can also help rule out other conditions.
Timeline of Symptoms
The timeline of symptoms varies widely from person to person.
Early stages: Gradual onset of lower back pain and stiffness, often worse in the morning.
Progressive stages: Pain and stiffness spread up the spine. Loss of spinal flexibility. Fatigue.
Advanced stages: Fusion of vertebrae leading to a fixed, stooped posture. Potential involvement of other joints. Possible organ involvement (eyes, heart, lungs). Symptoms can be intermittent with periods of flare and remission.
Important Considerations
Early diagnosis and treatment are crucial to slowing the progression of the disease and preventing long-term complications.
Individualized treatment plans are necessary, as the disease affects people differently.
Regular monitoring by a rheumatologist is important to adjust treatment as needed.
Comorbidities: People with AS are at increased risk for other health problems, such as cardiovascular disease and osteoporosis.
Mental health: Chronic pain can significantly impact mental health. Support groups and counseling can be helpful.
Pregnancy: Women with AS should discuss family planning with their rheumatologist and obstetrician.