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.
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.
The symptoms of ankylosing spondylitis are related
to inflammation of the spine, joints, and other organs. Fatigue is a common symptom associated with active inflammation. Inflammation of the
spine causes pain and stiffness in the low back, upper buttock area, neck, and
the remainder of the spine. The onset of pain and stiffness is usually gradual
and progressively worsens over months. Occasionally, the onset is rapid and
intense. The symptoms of pain and stiffness are often worse in the morning or
after prolonged periods of inactivity. The pain and stiffness are often eased by
motion, heat, and a warm shower in the morning. Because ankylosing spondylitis
often affects adolescents, the onset of low back pain is sometimes incorrectly attributed
to athletic injuries in younger patients.
Those who have chronic, severe inflammation of
the spine can develop a complete bony fusion of the spine (ankylosis).
Once fused, the pain in the spine disappears, but the affected individual
has a complete loss of spine mobility. These fused spines are
particularly brittle and vulnerable to breakage (fracture) when
involved in trauma such as motor-vehicle accidents. A sudden
onset of pain and mobility in the spinal area of these patients
can indicate bone breakage. The lower neck (cervical spine) is
the most common area for such fractures.
Chronic spondylitis and ankylosis cause forward curvature
of the upper torso (thoracic spine), which limits breathing capacity.
Spondylitis can also affect the areas where ribs attach to the upper
spine, further limiting lung capacity. Ankylosing spondylitis
can cause inflammation and scarring of the lungs, causing coughing
and shortness of breath, especially with exercise and infections.
Therefore, breathing difficulty can be a serious complication
of ankylosing spondylitis.
People with ankylosing spondylitis can also have arthritis in joints other than the
spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or
redness in joints such as the hips, knees, and ankles. Occasionally, the small
joints of the toes can become inflamed or "sausage" shaped. Inflammation can
occur in the cartilage around the breast bone (costochondritis)
as well as in the tendons where the muscles
attach to the bone (tendinitis) and in ligament attachments to bone.
Some people with this disease
develop Achilles tendinitis, causing pain and stiffness in the
back of the heel, especially when pushing off with the foot while
walking up stairs. Inflammation of the tissues of the bottom of the foot, plantar fasciitis, occurs more frequently in people with ankylosing spondylitis.
Other areas of
the body affected by ankylosing spondylitis include the eyes, heart, and
kidneys. Patients with ankylosing spondylitis can develop inflammation of the
iris (iritis),
the colored portion of the eye. Iritis is characterized by redness and pain in
the eye, especially when looking at bright lights. Recurrent attacks of iritis can affect either eye. In addition to the
iris, the ciliary body and choroid of the eye can become inflamed; this is
referred to as uveitis.
Iritis and uveitis can be serious complications of ankylosing spondylitis that
can damage the eye and impair vision and may require an eye specialist's
(ophthalmologist) urgent care. Special treatments for serious eye inflammation
are discussed in the treatment section below. (It should be noted that iritis
and inflammation of the spine can occur in other forms of arthritis such as
reactive arthritis [formerly known as Reiter's syndrome], psoriatic
arthritis, and the arthritis of inflammatory bowel disease.)
A rare complication of ankylosing spondylitis involves scarring of the heart's
electrical system, causing an abnormally slow heart rate (referred to as heart
block). A heart pacemaker may
be necessary in these patients to maintain adequate heart rate and output. In
others, the
part of the aorta closest to the heart can become inflamed, resulting in leakage
of the aortic valve. In this case, patients can develop shortness of breath, dizziness, and heart failure.
Advanced spondylitis can lead to deposits of protein
material called amyloid into the kidneys and result in kidney failure.
Progressive kidney disease can lead to chronic fatigue and nausea
and can require removal of accumulated waste products in the blood
by a filtering machine (dialysis).
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.
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.
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.
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.
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.
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.
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.
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.
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.
Arthritis RSS
Healthy Living Tips
This site complies with the