Ankylosing Spondylitis
Medical Author: William C. Shiel Jr., MD, FACP, FACR
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Ankylosing Spondylitis and Pregnancy
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.
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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
spinal inflammation (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 rheumatic 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 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, 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 two to three times more common
in males than in females. In women, joints away from the spine
are more frequently affected than in men. Ankylosing spondylitis
affects all age groups, including children. The most common age
of onset of symptoms is in the second and third decades of life.
What causes ankylosing spondylitis?
The tendency to develop ankylosing spondylitis is believed
to be genetically inherited, and the majority (nearly 90%) of patients
with ankylosing spondylitis are born with 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 have the
HLA-B27 gene, only 1% of the population actually have the disease
ankylosing spondylitis. In Northern Scandinavia (Lapland), 1.8% of the population have ankylosing spondylitis while 24% of the general population
have 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, their 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 body's
immune system by a 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.
Next: What are the symptoms of ankylosing spondylitis? »
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