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Definition
Ankylosing spondylitis is a disease of the joints especially of the spine, found commonly in early twenties or later. It is a type of chronic degenerative arthritis, where there is long standing inflammation of the spinal vertebrae, predominantly the joints between the spine and pelvis (sacroiliac joints), affecting more of the neck and/or lower back.

Ankylosing spondylitis is also called as Marie-Strumpell arthritis, Bechterew’s disease or Pierre- Marie’s disease. The name is derived from the Greek word where, “ankylos” means fusion or stiffening , “spondylos” means vertebra and “itis” means inflammation. As the name suggests, it leads to progressive fusion of the joints of the spine leading to painful stiffness of the back.

The patient is often seen walking with a stoop posture due to a rigid spine in the later stages. Hence it is also called as “bamboo” spine, as in the X ray film the spine looks stiff like a bamboo. 

Ankylosing spondylitis majorly affects the spine, but it can also involve the ribs, eyes, heart, lungs etc. 
Incidence:
It affects about 0.1% to 0.5% of the adult population. Males are more commonly affected than females. Ankylosing spondylitis can occur at any age but is often triggered in the men who are in their teens and adults between 20 to 40 years of age. When it affects the children the condition is called a juvenile ankylosing spondylitis.
Causes:
The causes include a combination of genetic and environmental factors.
Genetics: It is found that about 90% of individuals suffering from ankylosing spondylitis are born with the HLA B27 gene (Human Leukocyte Antigen). However, HLA B27 is not the absolute diagnostic criterion for the disorder. Many individuals suffering from similar symptoms might have the HLA B27 test negative, where the condition is known as seronegative ankylosing spondylitis. At the same time, all the patients who are positive for HLA B27 may not have actual Ankylosing Spondylitis.

Autoimmunity: The underlying mechanism which triggers this disorder is autoimmune, which is again genetically inherited.

Long standing stress: Stress can be a major triggering factor for ankylosing spondylitis. Individuals under prolonged stress situations give a sufficient reason to provoke this disorder at some stage in their life.
Early symptoms:
1. Pain and stiffness: Constant gradually increasing annoying pain and stiffness in the lower back, hips (sacroiliac joints) and sides of the lower back (loins). The pain may get aggravated after sitting for a long time or on sitting after standing for a long time. Patients often complain of morning stiffness which may awaken them early morning. The pain may generally improve with physical activity, while walking, having a warm bath and massage.

2. Limitation in normal movements: The bony fusion of the spine and vertebrae leads to impairment in the normal movements of the spine. It limits the person’s ability to perform daily routine activities. Fusion of the ribs to the spine causes difficulty in taking a deep breath.

3. Easy tiredness: This is the most common symptom that the patient usually complains about, which may be overlooked in the early stages. It may be mistaken for deficiencies like calcium and vitamin D and the diagnosis therefore can get delayed. The patient may say that “I get tired easily after walking longer distances which I could easily walk earlier”. He or she may complain of fatigue after walking for a short interval.

4. Loss of appetite and weight loss: Ankylosing spondylitis is a systemic disease where symptoms may not be only limited to the joints. Patients may gradually lose their weight and complain of loss of normal appetite.

5. Localized pain: There may be localized pain in knees, heel, ankles and feet where the tendons meet, as a result of inflammation and swelling.

6. Eye pain: Few groups of individuals suffering from ankylosing spondylitis complain of eye pain, redness and sensitivity to light due to inflammation of the anterior chamber of the eye (iritis or uveitis). 
Late Symptoms:
1. Stoop posture: The individuals at later stage attain a stooped posture due to permanent fusion of the spinal vertebrae.

2. Pain and stiffness: The intensity of pain and stiffness increases now and may not respond to previously administered pain relieving medicines.

3. Quality of life: The individuals may not be able to perform their daily routine activities as efficiently as before, that hampers the quality of life. 
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