Ankylosing Spondylitis

Thought I'd re-share some information from a talk given by Dr Alexander Brand, a consultant Rheumatologist which I attended in January 2012.

Ankylosing Spondylitis is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and non-articular structures. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. 


-         Predominently in 35 year old males

-         Always starts in the sacroiliac joint

-         May suffer from some other inflammatory disorder – psorasis, iritis, IBS

-         Morning stiffness that is prolonged – 60-90 minutes buttock pain and into the thighs

-         Systemically unwell – continual flu symptoms

-         CRP and ESR may be normal

-         HLA B27+ is high in only 90% of cases. If it is high does not mead you have AS. If it is low you still may have AS. Not definitive in diagnosis.

Main diagnosis test is MRI – will show bone marrow oedema of the SIJ.

Physiotherapy treatment

–        The main aim is maintain range of movement.

–        Swimming, is one of the preferred exercises since it involves all muscles and joints in a low-impact, buoyant environment.

–        Slow movement muscle extending exercises like stretchingyoga, climbing, t'ai chiPilates method, is recommended.

–        Moderate-to-high impact exercises like jogging are generally not recommended or recommended with restrictions due to the jarring of affected vertebrae that can worsen pain and stiffness in some patients.

–        Manipulation is contraindicated and has sometimes led to spinal fractures.


-         Pain relieving drugs – NSAID’s and opiod analgesics

-         Disease-modifying antirheumatic drugs (DMARDs) - used to reduce the immune system response through immunosuppression.

-         TNFα blockers (also known as biologics), are indicated for the treatment of and are effective immunosuppressants in AS as in other autoimmune diseases.