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Ankylosing Spondylitis

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    Ankylosing Spondylitis

    Background

         The Skeletal system act as the framework of the body, consisting of 206 bones in a normal adult, it protects organs, anchors skeletal muscles facilitate movements and act as storage for minerals. There are four types of bones, the long bones (e.g. femur), flat bones (e.g., sternum), short bones (e.g. metacarpals), and the irregular bones (e.g. vertebrae). Each significantly located in certain areas of the body. Interrelated to mobility, bones work hand in hand with muscles; each formed and facilitated by large amounts of connective tissues in the system. First there are the Ligaments which is an inelastic band that hold bones together, the junctions of the bones is called Joints, which allows movement to take place. The Cartilage is a flexible tissue that covers the ends of the bones, which prevents friction upon movements. While Tendons, are the one which attaches the muscles to the bones. Aside from connective tissues, there are also synovial membranes that secrete synovial fluid that act as a lubricant and shock absorber; this allows free movement and lesser degree of damage upon exertion.

         During heavy exertion, damage may occur to the ligaments and tendons resulting to inflammation. Inflammation is a common response of the body when a certain micro organism or damage takes place. It is an immune response that involves the release of monocytes and T-lymphocytes that creates a phagocytic reaction that produces pain and edema. In the Musculoskeletal system, the joints are primarily the common site of inflammation (Brunner & Suddarth 10th ed., 2004, p1606). Though the usual causes were sprain, strain, and fall, some may even be chronic (e.g. osteoarthritis, rheumatoid arthritis and gouty arthritis) or systemic in nature.

         Anklylosing Spondylitis or Rheumatoid Spondylitis is a type of spondyloarthropathies that is a chronic inflammation of the spine and the sacro-iliac joint, which affects the cartilage and may even involve the tendons and ligaments. The continuous inflammation on the site results to fusion which generally stiffens and reduces mobility. Underlying cause is still unclear though the initial inflammation may have been caused by bacterial or viral infection, which results to thickening of the membrane and accumulation of the synovial fluid that triggers release of white blood cells. In the case of Ankylosing Spondylitis the release of the inflammatory cells may have not been triggered off, turning into an autoimmune disorder. As a result continuous formation of scar tissues exists; this in time ossifies and causes fusion of the bones. Aside from bacterial infection, a probable cause that doctors are looking into is the presence of HLA- B27 in the genes, with almost 90% of patients with Ankylosis have this ( Shiel W. medicine.net); it has been made part of the laboratory exams needed for diagnoses.

         As inflammation became chronic, fatigue is the first one that alters normal human responses, relatively caused by the progressive pain and edema on the body. The presenting symptom of Ankylosing Spondylitis is long term sacral pain that spreads to the hips, lower back and neck. It worsens over a long period of time but eases with activities or a warm shower. Arthritis in joints may even occur, as most cases with Ankylosis also have other spondylarthropathies disorder such as Psoriatic arthritis, Reiter’s syndrome, and Enteropathic arthritis. As the disease became chronic, the bones start to fuse, leading to brittle bones that are vulnerable to fracture.

    Other conditions that may occur is the forward curvature of the torso, it results to the body’s inability to fully expand the chest due to the stiffness of the joints in the ribs. Therefore decreasing lung capacity, which in long term may cause breathing difficulty as scarring of the lungs may occur. And since it is a systemic disease, other complications to other organs might occur such as Iritis, an inflammation to the iris, Uveitis, an inflammation to the ciliary body and the choroids of the eye, Achilles Tendonitis, inflammation of the heel cord, and Plantar Fasciitis, inflammation of the plantar fascia or the heel bone that connects to the toes.

    Other organs that may also be involved are the heart and kidneys resulting to scarring of the heart’s electrical system and accumulation of amyloid, which is a protein that may precedent to kidney failure.

    Diagnoses of Ankylosing Spondylitis, involves Complete blood count which can help identify if there’s a presence of infection, an Erythrocyte sedimentation rate, which indirectly measures inflammation in the body, X-ray of the spine and pelvis, an HL-B27 antigen test, which looks for any presence of the protein, and last but not the least a physical assessment, which may present tenderness on the sacro-iliac joint and limitation during breathing exercises.

    Treatment to Ankylosis Spondylitis, are more on palliative care since direct treatment is still unavailable. Non-steroidal Anti-inflammatory drugs (NSAID), is commonly prescribed to relieve pain and inflammation, if NSAID’s does not work Sulfasalazine or Methotrexate may be given although liver test must be followed closely since it could lead to toxicity resulting to liver cirrhosis. The most promising drug so far is the Tumor Necrosis Factor- alpha blockers (TNF), which blocks the protein of inflammation, thus potentially slowing the progression.

         Other important thing to remember on the treatment is exercise and correct body posture.

    This promotes flexibility and prevents atrophy. Several exercises that can be done are stretching of the chest, back and other joints, which all depends on the severity and the joints affected. Using different range of motion will help to reduce pain and fatigue, as pain eases with activity. Maintaining correct body posture also keeps the body align in case the bone fused. Some posture regimen are being fostered by the Spondylitis Association of America, such as Think tall, wherein the chin should be horizontal and parallel to the floor, the other one is the Back against the wall, wherein the heels are four inches away from the wall; with the buttocks and shoulders touching the wall. In this exercise, straining should be avoided with a spine measurement alignment kept for references. And last but not the least is Prone lying, wherein one should lay prone with a towel on the forehead or under the chest for support. Other Exercise programs that are encouraged are Aerobics, because it helps in the expansion of the lungs. And another one is swimming, because it avoids jarring of the spine.

    Education is also an important factor for the patient as well as the care provider. Cigarette smoking is discouraged because of the limitation in the breathing pattern which may result to shortness of breathe. Ergonomics should also be kept in mind, chairs, bed and other fixtures should properly accommodate the patients back as well as his hips and lower body to prevent misalignment of the spines.

    Alternative treatment could also be use such as Acupuncture, since the stimulation on the acupuncture points helps relieve pain. Other treatments are also suggested and had benefited patients such as yoga, chiropractic treatment and massage, but most doctors don’t encourage this since any manipulation may cause fracture.

         For the nutrition of the patients, it is encouraged to maintain a healthy weight depending on one’s Body Mass Index. A good diet should be a regimen, focusing on calcium intake and vitamin D, avoidance of alcohol should done cause it may affect drug interaction, and a good amount of yogurt and banana intake will help in the digestion, as it helps protect the lining of the gut wall. Since some popular Non- Steroidal Anti-inflammatory drugs can cause damage to it.

    And if the problem may then be too severe especially on the hip area and the spine, surgery may follow.

    Work Cited

    “Ankylosing Spondylitis”. National Institute of Arthritis and Musculoskeletal and Skin             Disease. nlm.nih.org. 6 November 2007,         http://www.nlm.nih.gov/medlineplus/ankylosingspondylitis.html>.
    Marieb, Elaine.Essential of Human Anatomy and Physiology. Singapore: Pearson education

                Asia Pte Ltd, 2002.

    Shiel, William. “Ankylosing Spondylitis”. medicinenet.com. 6 November 2007,                <http://www.medicinenet.com/ankylosing_spondylitis/article.htm>.
    Smeltzer, Suzanne and Bare, Brenda. Brunner and Suddarth’s Textbook of Medical and

                Surgical Nursing. 10th Ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

    Spondylitis.org. 2007. Spondylitis Association of America. 6 November 2007,             <http://www.spondylitis.org/patient_resources/glossary.aspx>.

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