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New hope for ankylosing spondylitis sufferers

DUBAI - In a gathering of physicians from the AGCC held in Dubai recently, Professor Mohammad Asim Khan from Case Western Reserve University School of Medicine in Cleveland, US, shared the latest developments in the diagnosis and treatment of ankylosing spondylitis (AS), a disease that may affect one in every 200 people.

Ankylosing spondylitis is a type of arthritis that primarily affects the spine causing chronic back pain and stiffness. The term `ankylosing' means stiff or rigid while `spondylitis' refers to spinal inflammation.

In AS, the joints and ligaments that normally let the back move and flex become inflamed producing back pain and stiffness. People with AS often wake up in the middle of the night with back pain and feel very stiff in the morning. Typically, symptoms lessen with movement and exercise.

In time, the disease may progress into the upper spine, chest and neck and as a result the joints and vertebrae may fuse together, causing the spine to become rigid and inflexible. The disease is very much under-diagnosed and there is usually a delay of six years between the onset of the first symptoms and a correct diagnosis of AS.

Symptoms of AS first appear most frequently in young individuals, both men and women, usually between 16 and 30 years of age. The disease is three times less common in women, and may be more difficult to diagnose. It may sometimes start in childhood, more often in boys than girls, and Prof. Khan has suffered from AS since he was 12.

Ultimately, the inflammation can cause the sacroiliac and vertebral bones to fuse or grow together, resulting in the rib cage bones fusing together which leads to decreased chest expansion that can make breathing difficult. Inflammation and pain can also occur in the hips, shoulders, knees or heels, which may further limit mobility.

The cause of AS is unknown but genetic predisposition seems to play a big role. Generally, anti-inflammatory drugs will help reduce pain and improve the patient's sleep and general well-being.

This year the European Agency for the Evaluation of Medicinal Products has approved a medicine called Remicade (Infliximab) for the treatment of AS. This development has given new hope to the millions who are suffering from AS, which has not responded well to conventional therapy.

Results from published studies have demonstrated that treatment with Remicade leads to marked improvement in disease symptoms in more than 80 per cent of AS patients that had been resistant to conventional therapy.