Ankylosing spondylitis (part 1)
Ankylosing spondylitis is an autoimmune disease that is caused by immune reactions. However, there is little direct evidence of an autoimmune process specific to the HLA-B27 antigen, and there is evidence to suggest a greater role for an autoimmune process in pathogenesis.
There are still doubts about the initial location of the disease. TNF alpha plays an important role in the pathogenesis of this disease so that inhibition of this cytokine improves the disease and slows its progression.
Signs and symptoms of ankylosing spondylitis
Symptoms of the disease usually appear in late puberty or early adulthood. The average age of ankylosing spondylitis in Western countries is about 23 years old. In 5% of patients, symptoms begin after the age of 40.
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The first sign of ankylosing spondylitis is usually vague pain with an insidious, gradual onset that is felt deep in the lower back or serine area and is accompanied by morning dryness in the lower back for several hours. Morning dryness is caused by improved activity followed by inactivity.
Within a few months of the onset of the disease, back pain usually becomes persistent and bilateral. Exacerbation of pain at night makes the patient wake up and restless.
Other symptoms of ankylosing spondylitis include tenderness to the bone, which may be a sign of anthrax or osteitis.
Common sites of bone sensitivity include:
The junction of the ribs and the sternum.
The spinous process of the vertebrae.
Buttons of the tibia or tibial tubercle.
The heel of the foot.
Pelvic and shoulder arthritis is part of the axillary disease of the body. Pelvic or hip arthritis occurs in 25 to 30% of patients. Shoulder arthritis is much less common.
Occasionally in ankylosing spondylitis, severe arthritis of the pelvis alone or chest bone pain may be the patient’s current complaint, and symptomatic pelvic disease may be the main symptom.
Arthritis of the peripheral joints, such as the hands or feet, which is usually asymmetric, occurs in about 30% of patients. Pain and dryness of the neck due to the involvement of the cervical vertebrae are usually late signs of ankylosing spondylitis but are sometimes the main symptoms of the disease. A small number of patients, especially in the upper age group, present with constitutional symptoms.
In developing countries, the onset of ankylosing spondylitis is often at a young age. Peripheral arthritis and anthrax are usually the main symptoms of the disease, and in late adolescence, they are replaced by symptoms of the spinal, shoulder, and pelvic involvement.
Initially, the physical symptoms indicate inflammatory arthritis. The most specific symptoms include immobility of the vertebrae (with limited anterior flexion or forward flexion, lateral flexion or flexion to the left or right, and lumbar vertebrae or posterior flexion) and limited chest and lung opening.
Restriction of joint movement in ankylosing spondylitis is usually not commensurate with the severity of bony ankylosis and is thought to indicate muscle spasm due to pain and inflammation. Direct pressure or maneuvers that put pressure on the joints cause pain in the sacroiliac joints. In addition, there is usually tenderness in the spinous process and other sensitive areas of marked bone.