CME

JABATAN ANKYLOSING
SPONDYLITIS
BILIK
SEMINAR
JAB.
PATOLOGI HPSF

RABU
18/01/2017
JAM...3.30
Ankylosing spondylitis (AS) is a form of arthritis that
primarily affects the spine, although other joints can become
involved. It causes inflammation of the spinal joints
(vertebrae) that can lead to severe, chronic pain and discomfort.
In the most advanced cases (but not in all cases), this inflammation
can lead to new bone formation on the spine, causing the
spine to fuse in a fixed, immobile position, sometimes creating a
forward-stooped posture. This forward curvature of the spine is
called kyphosis.

AS can also cause inflammation, pain, and stiffness in other

areas of the body such as the shoulders, hips, ribs, heels,
and small joints of the hands and feet. Sometimes the eyes can
become involved (known as iritis or uveitis,) and, rarely, the
lungs and heart can be affected.

The hallmark feature of ankylosing spondylitis is the involvement

of the sacroiliac (SI) joints during the progression of the
disease. The SI joints are located at the base of the spine, where
Axial and Peripheral AS

There are different forms of the disease. Lower back

pain means you have axial AS. Pain and swelling in
joints other than your spine is called peripheral AS.
Disease Course/Prognosis

The severity of AS varies greatly from person to person, and not everyone will experience
the most serious complications or have spinal fusion. Some may experience only
intermittent back pain and discomfort, while others may experience severe pain and
stiffness over multiple areas of the body for long periods of time. AS can be debilitating
and, in some cases, lead to disability.
Almost all cases of AS are characterized by acute, painful episodes (also known as " flares"),
which are followed by temporary periods of remission when symptoms subside.
It is important to know that ankylosing spondylitis is a chronic, or lifelong, disease and
that the severity of AS has nothing to do with age or gender . It can be just as
severe in women and children as in men.
Remember that even if you have AS and are experiencing only mild symptoms, which you
are able to manage well, it is important to see your rheumatologist once a year in order to
detect and treat any underlying complications.
Causes
unknown, we do know that genetics play a key role in the disease. Most individuals who
have AS also have a gene that produces a "genetic marker," a protein called HLA-B27.
This marker is found in more than 95 percent of people in the Caucasian population with AS
(the association between ankylosing spondylitis and HLA-B27 varies greatly between ethnic
and racial groups.It is important to note, however, that one does not have to be
HLA-B27 positive to have AS. Also, a majority of people with this marker never
develop ankylosing spondylitis.
Scientists suspect that other genes--along with a triggering environmental factor such as a
bacterial infection, for example--are needed to activate AS in susceptible people. HLA-
B27 likely accounts for about 30 percent of the overall risk, but there are numerous other
genes working in concert with HLA-B27. Researchers have identified more than 60 genes
that are associated with AS and related diseases. Among the newer key genes identified are
ERAP 1, IL-12, IL-17, and IL-23.
One classic hypothesis has been that AS may start when the defenses of the intestines
break down and certain bacteria pass into the bloodstream, triggering changes in the
immune response.
Who Is at Risk?

Testing positive for the HLA-B27 marker

A family history of AS
Frequent gastrointestinal infections
Unlike other forms of arthritis and rheumatic diseases,
general onset of AS commonly occurs in younger
people, between the ages of 17 and 45. However, it can
also affect children and those who are much older.
Tests used to diagnose AS

erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and

complete blood count (CBC). If other causes such as rheumatoid
arthritis are suspected, testing for rheumatoid factor (RF) and
antinuclear antibodies (ANA) can help to rule out these conditions
Blood testsfor the HLA-B27 gene or signs of inflammation
X-ray. Remember, early on when you have AS, there may be no signs
of the disease on an X-ray. It usually shows up after several years.
Magnetic resonance imaging (MRI). An image of your sacroiliac joints
(where your spine connects to your pelvis) may show swelling and
inflammation.
CT scan. An image that uses X-rays
There a Cure?

Currently, there is no known cure for AS, but there are

treatments and medications available to reduce
symptoms and manage pain. Recent studies show that
the newer biologic medications can potentially slow
disease progression in some people. Note that different
people respond to different medications with varying
levels of effectiveness. Thus, it may take time to find the
most effective course of treatment.
What Are the Treatments?

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen,

indomethacin, meloxicam (Mobic), or naproxen
Corticosteroid shots in your joints
Disease-modifying antirheumatic drugs (DMARDs) like methotrexate or
sulfasalazine (Azulfidine)
Biologic DMARDs such as adalimumab (Humira), adalimumab-atto
(Amjevita), a biosimilar to Humira, etanercept (Enbrel), etanercept-szzs
(Ereizi), a biosimilar to Enbrel, golimumab (Simponi), infliximab
(Remicade), and infliximab-dyyb (Inflectra), a biosimilar to Remicade,
or secukinimab (Cosentyx).
Surgery can help a curved spine or neck, as well as damaged knees
and hips.
Are There Alternative
Treatments for AS?
Acupuncture
Massage
Yoga
Transcutaneous electrical nerve stimulation (TENS)
What Can I Do to Improve My
Quality of Life?
Keep moving.Daily exercise helps you stay flexible. It can help you
ease back pain and stiffness. A physical therapist can teach you how to
exercise safely. Work out in a warm pool to make movement easier.
Practice posture.Sitting and standing up straight may also help with
pain and stiffness.
Heat and cold.Using moist heat pads or taking hot showers can ease
your stiff, sore back. Cold packs can lower swelling in inflamed joints.
Healthy lifestyle and food choices.Keep a healthy body weight
or ask your doctor how you can lose weight if you need to. Extra pounds
stress your back and other joints. Smoking makes AS worse.
Whats It Like Long-Term When
You Have AS?
AS shouldnt affect how long you live.You may have
mild back pain that comes and goes. But if your
disease is more. The rib cage can severe, your spine
may curve or stiffen over time and may become fused
also become fused, making it hard to take a deep
breath.