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).
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