What is it?
Ankylosing Spondylitis is a rheumatic disease mainly affecting the spine and particularly the joint between the hip bone and the spine - a condition called sacro-ileitis.

How does it occur?
Following periods of inflammation, as healing occurs, bone grows out from both sides of the vertebrae (bones of the spine), and may join them together causing stiffness and immobility (bamboo spine).

What is the cause?
The cause is unknown but there are certain factors, which may predispose to the condition:
1. There is an increased incidence of Ankylosing Spondylitis in inflammatory bowel disease (around 10 - 20 times more common than would be seen in the general population).
2. If a first-degree relative has IBD, the chances of Ankylosing Spondylitis are increased.
3. There is a genetic tendency. Around 90% of patients with Ankylosing Spondylitis have the white cell group HLA-B27. However, many other members of the general population (including siblings of sufferers) also having this blood group, never develop the disease.

What are the symptoms?
Ankylosing Spondylitis is a progressive disease; i.e. it starts off with maybe only minimal effects, which gradually get worse over the course of time.
Early signs may show:
• low backache and stiffness
• aches and pains in the neck, shoulder and hip
• sciatica-type pain felt down the thigh

These may be mild and intermittent causing few troubles, or more active causing weight loss, fatigue and a general feeling of being unwell. Other joints such as the hip, knee and ankle may be affected causing similar problems to those of the spine.

How do I know that I have the condition?
Backache may be present for several years. Tests, which eventually may lead to a diagnosis, include:
1. A blood test
The erythrocyte sedimentation rate (ESR) will be raised indicating inflammation.
2. X-rays
X-rays of the sacro-iliac joints and spine.
3. HLA-B27 antigen test
This is similar to blood grouping, but is looking at the white cells. If positive, this may indicate the possibility of the disease.

What is the treatment?
Treatment generally involves pain relief and keeping fit and healthy.

The disease is slowly progressive, but symptomatic relief is achievable and a full life can usually be enjoyed.

Posture
It is important to keep as good a posture as possible, keeping the back straight at all times.
• Avoid stooping over a desk at work.
• Avoid sitting in one position for too long without moving the back.
• Corsets and braces may make the condition worse as muscles that support the back may become weak due to immobility.
• A firm bed may provide more comfort in keeping the spine straight. A board can be applied under the mattress if necessary.

Sport and exercise
Keeping active is helpful. Swimming, in particular, allows good use of all muscles and joints without injury.

Diet
Research has shown that diet may have an affect on the treatment of Ankylosing Spondylitis. The organism Klebsiella has been isolated in stools of patients with active disease and improvements have been achieved by giving a low carbohydrate diet. These patients have also been found to be HLA-B27 positive.