spondylitis
(spon-dĭ-līt'ĭs 
)
[spondylo- + -itis]
Inflammation of one or more vertebrae.
ABBR: AS
A chronic, progressive, inflammatory disorder of the spine (and other organs) that causes low back pain, stiffness, and deformity.AS is found in approx. 5 of every 1000 people of European ancestry, and unlike other rheumatological diseases, it affects men more often than women.
The cause of AS has not been identified, but the disease is known to be inherited.
Low back pain and stiffness while at rest that is relieved by movement are characteristic symptoms. Over time, the spine may become ankylosed (rigid and bowed forward), a condition known colloquially as a “poker spine.” Although AS primarily involves the sacroiliac (SI) joints and lumbar spine, it may have effects outside the skeleton, e.g., on the eyes (it may cause iritis or anterior uveitis), the aorta, or the heart valves.
AS is diagnosed when a patient has low back pain and stiffness that gradually becomes worse and does not improve after 3 months; if the pain is worse while the patient is resting; and if the stiffness is improved by stretching, warm-up, or exercise. People with AS have a high incidence of a specific human leukocyte antigen (HLA-B27), which may predispose them to the disease. Changes occurring in the axial skeleton are similar to those seen in rheumatoid arthritis. The pain of AS should be alleviated by nonsteroidal anti-inflammatory drugs. Radiographic imaging of the lower back usually reveals sclerosis of both SI joints in patients with established disease. Early in its course, SI joint sclerosis may not be radiographically visible.
There is no known prevention of AS.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen, should be given to patients suspected of having AS. Relief of symptoms is a characteristic finding. Tumor necrosis factor inhibitors, such as etanercept or adalimumab, may be given to prevent symptoms of disease, and in some cases irreversible arthritic degeneration of the spine.
The severity of AS varies from person to person, but the younger the age of diagnosis, the worse the disease. Typically those patients who have little clinical or x-ray evidence of disease progression after 10 years do well. By contrast, patients who have progressive disease early in their course usually suffer more complications, including restriction of the spine, restrictive lung disease, arthritic changes in the hip joints, and extra-articular involvement. For reasons that remain unclear, smokers have a worse prognosis than nonsmokers.
All patients suspected of having nonmechanical (inflammatory) low back pain may benefit from seeing a rheumatologist to discuss the potential risks and benefits of tumor necrosis factor inhibitors and other contemporary drug treatments for AS. In addition to drug therapies, patients with AS should be encouraged to exercise regularly and to participate actively in recommended forms of physical therapy. SYN: Marie-Strümpell spondylitis; rheumatoid spondylitis; Strümpell disease; Strümpell-Marie disease.
s. deformans Spondylitis resulting in the outgrowth of bonelike deposits on the vertebrae, which may fuse and cause rigid and distorted spine.
hypertrophic s.Spondylitis in which the bodies of vertebrae hypertrophy. It occurs in most people over 50. Bony changes such as facet degeneration and the formation of bone spurs commonly occur.
Kümmell s.A traumatic spondylitis in which symptoms do not appear until some time after the injury.
Marie-Strümpell s.Ankylosing spondylitis.
rheumatoid s.Ankylosing spondylitis.
SEE: under Pott, John Percivall.