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Dr. Theo on Arthritis Continued


If you wake up in the morning with lower back pain and stiffness, if you've had the low back pain for longer than three months, and if it gets better with exercise but is not improved with rest. you may have ankylosing spondylitis (AS).

Causing fused spinal vertebrae, AS is most commonly seen in young men. It sometimes goes untreated in earlier stages because it can easily be confused with mechanical back pain, the kind you get from lifting a heavy object. With AS, the tendons and ligaments that move the back become inflamed. The vertebrae respond to the problem by producing more bone. The body's response is well intentioned, but making extra bone can cause the vertebrae to grow into each other and fuse together. Eventually, the spine can wind up looking like a bamboo pole. It gets so stiff that the natural inward curvature of the low back and the natural extension of the neck are lost, making AS sufferers appear bent over. They don't really have trouble holding up their heads-their neck vertebrae are fused in that position. If you have ever seen an elderly person walking bent over as though he were looking at his shoes, you have probably witnessed the late stages of AS.

AS inflammation usually begins in the lower back, and always involves the sacroiliac joints (the joints where the lower spine meets the pelvis). In later stages the middle and upper back and neck are afflicted. The disease can spread down into the buttocks and thighs, or up into the chest, where it can make deep breaths difficult. The inflammation may also strike the joints of the shoulder, knees, or ankles. It can also affect the eyes about 30 percent of patients with AS will develop anterior uveitis (inflammation of the iris) at some point. In fact, in some 20 percent of AS cases, the first signs of arthritis appear in the knees, hips, heels, or eyes.

Young men between 16 and 35 years of age are the favorite targets of AS, which afflicts approximately I in 1,000 people under the age of 40. Three times as many males as females are diagnosed with the disease, but this may be because females tend to have much milder symptoms and may never be diagnosed. It also appears in children (mostly boys), who account for roughly 5 percent of the cases. It is rarely seen in African Americans.

Scientists have found what may prove to be a genetic basis for AS. The disease is found almost exclusively in those who have the HLA-B27 gene, a gene involved in fighting infection. But don't worry if you carry HLA-B27-less than 5 percent of those with the gene eventually develop the disease. It's not enough simply to have the genetic tendency the gene has to be "switched on" somehow. (If one identical twin develops AS, it appears in the other twin only 60 percent of the time.) Studies currently under way are looking into the possibility that a certain type of infection triggers AS.

Early diagnosis and proper treatment of AS can reduce or prevent deformity. The treatment regimens are designed to reduce pain and prevent deformities, while strengthening the back and neck. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and inflammation but do not prevent progression of the disease. Exercise and posture improvement help to increase strength and flexibility. The new biologic agents infliximab and etanercept show great promise in the treatment of AS. Not only do they help decrease pain and increase flexibility in patients with AS, they can also slow or even stop progression of the disease. In July 2003 etanercept (Enbrel) was approved by the FDA for treatment of AS. Glucosamine and chondroitin are often used by AS sufferers, but mainly in an effort to decrease their reliance on NSAIDs. Some patients report that the supplements glucosamine and chondroitin sulfate help, but no formal studies on these supplements or ASU have been done yet.


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90% of people who follow The Arthritis Cure treatment program don't need anti-inflammatories (like Aleve, Celebrex or Advil).
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