It is estimated that between 300,000 and 750,000 people in the United States are suffering with ankylosing spondylitis (AS), with 75% of the cases being men, with symptoms typically presenting in their twenties.

Akylosing spondylitis is a hereditary auto-immune disease that causes chronic inflammation of the joints in the spine and the sacroiliac joing (where the spine joins with the pelvis). Eventually the joints of the spine may fuse together, causing immobility.

Prognosis of AS is difficult to predict, as the course of the disease can range from mild to very debilitating, and treatments are not always effective.

Symptoms usually begin with chronic pain and stiffness in the mid-spine, lower spine, or entire spine with referred pain to the buttocks and the back of the thigh. Pain typically occurs at night or during periods of inactivity, and may improve with activity and exercise. Additionally, about 40% of patients will experience inflammation in the eyes (iritis, uveitis) which can cause redness, pain, and vision loss. Fatigue, nausea, and weight loss are common, as well as join pain and swelling in the knees, shoulders, and ankles. Breathing may sometimes become difficult because the stiffening of the spinal joints will also affect the ribs, leading to difficulty expanding the chest for full inspiration. Some patients (although rare) may suffer cardiac problems such as aortic regurgitation and heart block. The lungs may show fibrosis as well.

There is no definitive test to diagnose ankylosing spondylitis, but MRI and X-ray imaging of the spine can show the changes that occur as the disease progresses. A genetic test for the HLA-B27 genotype helps in diagnosis, but is not definitive (90% of AS patients will have this gene, but not everyone with the gene has AS). During periods of acute inflammation, blood tests for inflammatory markers may be present (C-reactive protein (CRP), and a high erythrocyte sedimentation rate (ESR).

There is no cure for AS, but there are several treatments. Usually physical therapy and exercise are used heavily because they help to reduce pain and stiffness. There are several medications used for pain relief, primarily non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, diclofenac) and COX-2 inhibitors (Celebrex). Opiate painkillers may be required in cases of extreme pain. Immunosuppressant drugs such as disease modifying anti-rheumatic drugs (DMARDS; cyclosporine, methotrexate) and corticosteroids help reduce inflammation, as do biologic drugs (TNF-alpha blockers; Enbrel, Remicade, Simponi, Humira). Surgery may be considered when symptoms are severe (knee and hip replacement, back surgery to straighten the spine).

The National Institutes of Health defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. CAM therapies used alone are often referred to as "alternative." When used in addition to conventional medicine, they may be referred to as "complementary.” The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

Americans spend more than $1 billion a year on nontraditional treatments for arthritis. The reasons for seeking CAM treatments vary – many people want relief for pain and suffering that traditional medications have not provided; they hope to avoid potentially serious side effects associated with such medications; and certain conventional medical and surgical treatments cost more than many of us can afford.

Although there has been no rigorous scientific evidence to support the use of CAM by people with ankylosing spondylitis (AS) and its related diseases, some patients have benefited from such treatments.

Review Date: 
April 13, 2012