Spinal Arthritis (Ankylosing Spondylitis; Marie-Strumpell Disease)
Spinal arthritis is a chronic, progressive joint disease that affects mostly men. The condition's medical name, ankylosing spondylitis, comes from Greek words that describe what happens as the disease progresses: the spine (spondyl) becomes inflamed (itis) and the vertebrae fuse together (ankylosing). An estimated 300,000 Americans have been diagnosed with spinal arthritis, but the actual incidence may be much higher, because a large number of cases are so mild that they go undetected for decades.
The cause of spinal arthritis is unknown, but there is probably a hereditary predisposition In many cases, a specific genetic marker, designated as HLA-B27, shows up in blood tests.
Although the disease process may begin in childhood, the first symptoms typically show up between ages 15 and 30. Early indications include severe pain and stiffness in the affected joints, which may be accompanied by fatigue, loss of appetite, and perhaps an intermittent low-grade fever. The spinal inflammation typically begins around the sacroiliac joints, where the lowermost spine (the sacrum) connects with the pelvic bone (ilium). The disease usually progresses up the spine, sometimes as high as the neck. It also affects other joints, including the shoulders, knees, or ankles. The inflammation causes overgrowth of the bones. As the spinal column becomes more rigid, the vertebrae may fuse so that the person has a permanently stooped posture, a major characteristic of the disease.
Some patients also suffer inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease; heart-valve abnormalities; and/or related eye inflammation.
Diagnostic Studies and Procedures
Spinal arthritis is diagnosed on the basis of family history, a physical examination, X-rays, and blood tests. The presence of the genetic marker helps confirm the diagnosis, but its absence does not rule out the disease.
Medical Treatment
Although no medical cure exists for spinal arthritis, drugs play an essential role in reducing inflammation and pain. The condition appears to be less responsive to aspirin than most other inflammatory joint disorders, but some patients find they can manage with over-the-counter non-steroidal anti-inflammatory drugs (NSAlDs) in the ibuprofen category (Advil, Motrin, Nuprin, and others). The most effective prescription drug for spinal arthritis is indomethacin (lndocin), one of the more potent NSAlDs.
A corticosteroid shot can alleviate a sudden flare-up. However, steroids are not a part of long-term treatment because of their serious side effects, which include lowered immunity, bleeding problems, and bone loss.
Various braces may be used to hold the back straight and prevent fusing of the spinal column in a stooped position. Surgery is sometimes recommended in advanced cases to remove some of the bone overgrowth and improve posture.
Alternative Therapies
Acupuncture. For some people, occasional treatments by an acupuncturist reduce the amount of pain-killing medication they need to do their exercises.
Alexander Technique. Patients with severe spinal arthritis tend to stoop because this posture is less painful than standing erect. After analyzing the individuals way of standing, sitting, and performing daily tasks, a therapist of the Alexander technique can recommend special preventive exercises that will help retain as much spinal flexibility as possible. If fusing is inevitable, it is preferable to have the spine in a rigid upright position rather than one that is bent forward.
Hydrotherapy. Swimming and exercising in warm water helps maintain muscle tone and strength without putting undue stress on weight-bearing joints. Whirlpool baths and water massage can alleviate joint pain.
Occupational Therapy. An occupational therapist can provide suggestions on how best to perform daily tasks.
Physical Therapy. Daily exercise is a critical aspect of managing spinal arthritis. A physical therapist can help devise a suitable regimen that will stretch and strengthen the muscles surrounding the affected joints so that
they remain flexible. The therapist may also teach deep-breathing exercises, especially if the rib cage is deformed.
Psychotherapy. Spinal arthritis can take a heavy emotional toll, especially if it produces disability and deformity. Counseling may be helpful in coping with the problems of living with a progressive chronic disease. Joining a support group may also prove beneficial.
T'ai Chi. The gentle range-of-motion exercises of t'ai chi can help maintain strength and flexibility, even if a person is unable to perform all of the prescribed movements.
Self-Treatment
To keep the spine as straight as possible, even during the night, doctors advise sleeping on your back on a hard mattress, with your body stretched out full-length and without pillows under your head. Always avoid slouching. If your job entails sitting, make sure your chair provides proper back support.
When driving, always wear your seat belt and adjust your head rest for maximum support. A pillow behind the small of your back eases strain. You may need to wear neck and back braces for additional support; discuss this with your doctor or physical therapist.
Other Causes of Back Symptoms
Back pain may result from muscle spasms, a ruptured disk, an injury, an infection, spinal stenosis, and other forms of arthritis.