Signs
and Symptoms of Ankylosing SpondylitisMost commonly ankylosing spondylitis
presents with lower back pain first, but in women and
children it is not unusual that the first presentation would be joint pains in
arms or legs. Sometimes it might even present with an acute eye inflammation (acute
iritis or anterior uveitis). Recurrent back pains, which mostly occur at nights,
and morning stiffness are common. This improves with
moving about (Ref. 2). Inflammation in the sacroiliac
joints (sacroiliitis)manifests itself by buttock
pains either only on one side or on both. This is worse with rest and tends to
get worse with weight bearing. This can be confused with irradiating pain from
a disc herniation and when a CT scan of the spine is normal, the ankylosing spondylitis
might be missed. There might be chronic inflammatory changes followed by
bone spur formation deep inside the sole of the feet (plantar fasciitis)
or at the insertion of the Achilles tendons at the calcaneous bones. These lesions
are called "enthesis lesions" (Ref. 1) and
this shows up on X-rays. Eye lesions such as conjunctivitis
happen in about 33% of Reiter's syndrome. In about 4% of patients with any spondyloarthropathy
(including ankylosing spondylitis) an acute inflammation of the iris occurs. This
condition is called "anterior
uveitis" by the eye specialist and has the potential to reoccur.
The more it reoccurs, the more difficult it is to treat and can in a few patients
can become the cause of blindness. The costovertebral joints, which allow
the ribs to move up and down with breathing, tend to become stiff and as a result
the chest expansion becomes limited with ankylosing
spondylitis. As long as the person is not excessively overweight, the diaphragm
can compensate to a certain extent, but the overall exercise tolerance is decreased.
As over the years the spinal connections via the facet joints and the interspinal
ligaments become stiff and immobile, the spine becomes forward bent permanently,
which is called "kyphosis". More rare systemic symptoms from ankylosing
spondylitis are nerve compressions (sciatica, radiculitis) and heart problems
(leaky aortic valve, irregular heart beats, pericarditis). Also rare is a lung
fibrosis condition, which affects the upper lungs and can sometimes be misdiagnosed
on X-rays as "tuberculosis", when in reality it is not. However, this
can be complicated by a fungal superinfection ("aspergillosis") (Ref.
2, p. 446).
|
