ANKYLOSING SPONDYLITIS

What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is a rheumatic disease that causes arthritis to the spine and sacroiliac joints. It can also cause inflammation in the heart valves, lungs, and the EYES. It can vary from intermittent episodes of back pain that occurs throughout life to a severe chronic disease that attacks the spine, peripheral joints and other body organs. This can all result in: severe joint and back stiffness, loss of motion and deformity as life progresses.

Cause: The cause of AS is unknown, however there is a common genetic marker to all spondylarthropathies : HLA-B27.

Epidemiology: Young males between the ages of 20 and 40. Most common ethnic group is Native Americans

Dx: A dramatic loss of flexibility in lumbar spine is an early sign of AS. Most symptoms begin in the lumbar and sacroiliac areas, but they may progress to and involve the neck, upper back, shoulders, hips, and feet. Some people may also have inflammatory bowel disease, fever, fatigue, weight loss, anemia, and IRITIS. More severe cases involve heart valve dysfunction.

Ocular Manifestations: Acute attacks of Iritis Mild to moderate anterior chamber reaction associated with iridocyclitis. Posterior synechia develops rapidly. Chronic uveitis may lead to increased IOP, development of cataracts, and macular edema.

Treatment: Systemic Physical Therapy Antiinflammatories NSAIDS indomethacin Ocular Topical cycloplegic and steroid preparations need to be given quickly to prevent any synechiae formation. A longer lasting cycloplegic agent would work better to prevent the posterior synechiae, such as: scopolamine vs homatropine. Antiglaucoma medication, if secondary GLC.