Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Medical Author: William C. Shiel Jr., MD, FACP, FACR
The influence of pregnancy, delivery, and the
post-partum period is a common concern of persons with arthritis and related
conditions. Although ankylosing spondylitis occurs predominantly in men (two to three
times more common in males than in females), women can and do develop the disease.
This topic of pregnancy and ankylosing
spondylitis was studied and published under the title "Ankylosing
spondylitis--the female aspect" (J Rheumatol 1998 Jan;25[1]:120-4). I think
this study serves well as a review of pregnancy issues in women with ankylosing
spondylitis.
In
collaboration with the Ankylosing Spondylitis International Federation, a
questionnaire including clinical data and details on
past and recent pregnancies was sent to the female members of national and
regional Ankylosing Spondylitis societies in the USA, Canada, and 11 European
countries. (It should be noted that questionnaires do have shortcomings from a
research standpoint, including inaccurate completion of the forms, lack of
personal interaction, and accurate interpretation of both the questions and the
responses.)
Nine hundred thirty-nine questionnaires were completed. The
researchers found that the average age of the responding women at the onset of
their ankylosing spondylitis was 23 years. In 21% of these women, the onset was
related to a pregnancy, either occurring during or immediately after the
pregnancy.
In this
group, the frequency of accompanying features of ankylosing spondylitis was as
follows: 45% had inflamed joints away from the spine (peripheral arthritis); 48%
had inflammation of the iris of the eye (acute anterior uveitis); 18% had
psoriasis; and 16% had inflammatory bowel
disease.
Ankylosing spondylitis belongs to a group of
arthritis conditions which tend to cause chronic inflammation of the spine
(spondyloarthropathies).
Ankylosing spondylitis affects males two to three times more
commonly than females.
Ankylosing spondylitis is a cause of
back pain in
adolescents and young adults.
The tendency to develop ankylosing spondylitis is
genetically inherited.
The HLA-B27 gene can be detected in the blood of most
patients with ankylosing spondylitis.
Ankylosing spondylitis can also affect the eyes, heart,
lungs, and occasionally the kidneys.
The optimal treatment of ankylosing spondylitis
involves medications that reduce inflammation or suppress immunity,
physical therapy, and exercise.
What is ankylosing spondylitis?
Ankylosing spondylitis is a form of chronic inflammation
of the spine and the sacroiliac joints. The sacroiliac joints
are located in the low back where the sacrum (the bone directly
above the tailbone) meets the iliac bones (bones on either side
of the upper buttocks). Chronic inflammation in these areas causes
pain and stiffness in and around the spine. Over time, chronic
inflammation of the spine (spondylitis) can lead to a complete cementing
together (fusion) of the vertebrae, a process referred to as ankylosis.
Ankylosis leads to loss of mobility of the spine.
Ankylosing spondylitis is also a systemic disease, meaning it can affect other tissues throughout the body. Accordingly, it
can cause inflammation in or injury to other joints away from the spine, as
well as to other organs, such as the eyes, heart, lungs, and kidneys.
Ankylosing spondylitis shares many features with several other
arthritis
conditions, such as psoriatic arthritis, reactive arthritis (formerly called Reiter's disease), and arthritis
associated with Crohn's disease and ulcerative colitis.
Each of these arthritic conditions can cause disease and inflammation
in the spine, other joints, eyes, skin, mouth, and various organs.
In view of their similarities and tendency to cause inflammation
of the spine, these conditions are collectively referred to as
"spondyloarthropathies." Ankylosing spondylitis is considered one of the many rheumatic diseases because it can cause symptoms involving muscles and joints.
Ankylosing spondylitis is two to three times more common in men than in women. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. When it affects children, it is referred to as juvenile ankylosing spondylitis. The most common age of onset of symptoms is in the second and third decades of life. Ankylosing spondylitis is often abbreviated AS and has been referred to as Bechterew's disease.
What causes ankylosing spondylitis?
The tendency to develop ankylosing spondylitis is believed
to be genetically inherited, and a majority (nearly 90%) of people
with ankylosing spondylitis are born with a gene known as the HLA-B27 gene. Blood
tests have been developed to detect the HLA-B27 gene marker and
have furthered our understanding of the relationship between HLA-B27
and ankylosing spondylitis. The HLA-B27 gene appears only to increase the tendency of developing ankylosing spondylitis, while some additional factor(s), perhaps environmental, are necessary for the disease to appear or become expressed. For example, while 7% of the United States population has the HLA-B27 gene, only 1% of the population actually has the disease ankylosing spondylitis. In
northern Scandinavia (Lapland), 1.8% of the population has ankylosing spondylitis while 24% of the general population has the HLA-B27 gene. Even among HLA-B27-positive individuals, the risk of developing ankylosing spondylitis appears to be further related to heredity. In HLA-B27-positive individuals who have relatives with the disease, the risk of developing ankylosing spondylitis is 12% (six times greater than for those whose relatives do not have ankylosing spondylitis).
Recently, two more genes have been identified that are associated with ankylosing spondylitis. These genes are called ARTS1 and IL23R. These genes seem to play a role in influencing immune function. It is anticipated that by understanding the effects of each of these known genes researchers will make significant progress in discovering a cure for ankylosing spondylitis.
How inflammation occurs and persists in different
organs and joints in ankylosing spondylitis is a subject of active research. Each individual tends to have their own unique pattern of presentation and activity of the illness.
The initial inflammation may be a result of an activation of the body's
immune system, perhaps by a preceding bacterial infection or a combination of infectious microbes. Once activated, the body's
immune system becomes unable to turn itself off, even though the
initial bacterial infection may have long subsided. Chronic tissue
inflammation resulting from the continued activation of the body's
own immune system in the absence of active infection is the hallmark
of an inflammatory autoimmune disease.
Ankylosing Spondylitis - Symptoms at Onset of DiseaseQuestion: The symptoms of ankylosing spondylitis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Bone spurs are pointy outgrowths of bone that develop in areas of inflammation or injury. They commonly occur on the heel and spine and may be the result of reactive arthritis, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis. Symptoms include pain, numbness, and tenderness. Treatment focuses on decreasing inflammation and avoiding re-injury.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Costochondritis is inflammation of the cartilage where the ribs attach to the sternum. Tietze syndrome affects the same region of the chest and causes inflammation, tenderness, and swelling. Anti-inflammatory medications, rest, physical therapy, and cortisone injections are suitable methods of treatment for both costochondritis and Tietze syndrome.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Kyphosis is outward curvature of the thoracic spine (upper back). Abnormal kyphosis results in the appearance of a hunchback, which is accompanied by back pain, stiffness, and muscle fatigue in the back. There are three types of abnormal kyphosis: postural, Scheuermann's, and congenital kyphosis. Postural kyphosis is caused by poor posture and a weakening of the back's muscles and ligaments. Scheuermann's kyphosis is caused by a structural deformity of the vertebrae. Congenital kyphosis is caused by an abnormal development of the vertebrae prior to birth. Treatment of kyphosis depends upon the type of kyphosis the patient has.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Iritis is inflammation of the iris, the colored portion of the eye. Symptoms include a red, painful eye, blurry vision, and light sensitivity. Treatment usually involves cortisone eyedrops.
Scleritis is inflammation of the white part of the eye. It may be caused by a serious underlying condition, such as an autoimmune disease. Symptoms include redness, pain, tearing, sensitivity to light, and decreased visual acuity. Treatment may include eye drops as well as treatment for any underlying disease process. Scleritis cannot be prevented.
A urinalysis is simply an analysis of the urine. It is a very common test that can be performed in many healthcare settings including doctors' offices, urgent care facilities, laboratories, and hospitals.
It is performed by collecting a urine sample from the patient in a specimen cup.
Usually only small amounts (30-60 ml's) may be required for urinalysis testing.
The sample can be either analyzed in the medical clinic or sent to a laboratory
to perform the tests. Urinalysis is abbreviated UA.
Urine can be evaluated by its physical appearance (color, cloudiness, odor,
clarity), or macroscopic analysis. It can be also analyzed based on its chemical
and molecular properties or microscopic assessment.
Urinalysis is ordered by doctors for a number of reasons, as follows:
Routine medical evaluation: general yearly screening, assessment before
surgery (pre-operative assessment), admission to h...
