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Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis of the back that causes inflexibility, stiffness and pain. Spondylitis means inflammation of the spine and ankylosing refers to the fusion of two adjacent bones. It is twice as common in men as women and may go undiagnosed for many years. People traditionally describe back pain / stiffness (or other body pain) that lasts for > 30 mins in the morning, that improves with exercise or as the day progresses but sometimes wakes them from sleep.

Ankylosing Spondylitis belongs to the spondyloarthritis family of diseases that also includes psoriatic arthritis, enteropathic arthritis (crohn’s disease and ulcerative colitis) and reactive arthritis. Spondyloarthritis can affect the skin, lung, eye, bowel, nails, tendons, joints other than the spine, etc. Inflammation in the spine is triggered by an unknown source and usually continues unless anti inflammatory or immunosuppressant medication is used. It can be described as an autoimmune or auto-inflammatory disease where  the body’s immune system attacks its own healthy cells and tissues. People can often feel fatigued and unwell with these conditions and it can take sometime after disease remission induction for these constitutional symptoms to improve.

Early detection and treatment usually prevents longterm damage. As of September 2018 we have 5 major classes of therapeutics to help treat spondyloarthritis inclusive of NSAID’s & COXIB’s, TNF inhibitors, anti IL-17 drugs, anti IL12 / 23 drugs and JAK inhibitors are in evolution. Idiosyncrasies of each spondyloarthritis may direct further therapies.