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Ankylosing Spondylitis

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About Ankylosing Spondylitis (AS)

Ankylosing Spondylitis can be one of the Extraintestinal Manifestations seen with IBD.

Ankylosing Spondylitis (AS) is an Inflammatory disease of the spinal column and pelvis. It is a Chronic disease which leads to fusion of the affected joints. AS can cause Chronic Pain and stiff joints. Most often in the lower back and/or hips.

Ankylosing Spondylitis (AS) is a Chronic type of Arthritis affecting the Spine and Sacroiliac Joint. It primarily affects males in their mid 20s, although females can also be affected by the disease. [5] AS Symptoms often begin in the 20's (but symptoms can begin earlier or later). Pain is typically worse during periods of immobility (such as at night or in the morning). Risk factors include: Family History of AS, Genetics, and frequent Gastrointestinal (GI) or Urinary Tract Infections. [4] Many people with AS also have Crohn's Disease or Ulcerative Colitis.

Common Symptoms:

Anemia (mild to moderate)[4]
Fatigue [4]
Lower Back / Buttocks Pain and Stiffness [4]
Pain in Joints may spread up the Spine, Neck and Peripheral Joints[4]
Uveitis

Joints Affected:

Rarely, patients with AS have pain in small joints or joints of the arm. Typically joints affected by AS include:
Hip[4]
Knee[4]
Neck[4]
Ribs[4]
Sacroiliac Joint (Typical Presenting Joint) [4]
Shoulder[4]
Spine[4]

Laboratory and Diagnostic Tests:

- Anemia (Mild)
- ESR (Erythrocyte Sedimentation Rate) - shows presence of Inflammation but is not specific for AS nor is it elevated in all AS patients[4]
- MRI (or X-Ray) showing damage to the Sacroiliac Joint (may not be seen in early disease) [4]
- RF (Rheumatoid Factor) - Negative[4]
- ANA (Anti Nuclear Antibody) - Negative[4]

Treatment:

Acupuncture[32]
Biologics (Anti - Tumor Necrosis Factor (TNF) Agents) [5] [4]
Diet[4]
DMARDs[4]
Exercise[4]
Massage[4]
NSAIDs **To be used with caution in patients with GI Disease[4]
Surgery[4]
Transcutaneous Electrical Nerve Stimulation (TENS)[4]
Yoga[4]

Please view the CrohnsForum.com Wiki Page on Arthritis for more information about AS and other joint diseases.

Clinical Trials for Ankylosing Spondylitis

Clinical Trial: Drug / MedicationStudyTrial IdentifierSponsor
AIN457 (Secukinumab)
Safety, Tolerability and Efficacy of Secukinumab (AIN457) in Patients With Active AS (MEASURE 1)NCT01358175Novartis Pharmaceuticals
Apremilast
Study of Apremilast to Treat Subjects With Active AS (POSTURE)NCT01583374Celgene Corporation
Baraclude (Entecavir)
Study of Anti-Viral Prophylaxis for HBsAg(+) or HBcAb(+)/HBsAb(-) Patients Starting Anti-TNFα. Entecavir Baraclude (Bristol-Myers Squibb)NCT01694264Seoul National University Hospital
Humira® (Adalimumab)
Adalimumab (Humira®) Effectiveness in Patients With AS and Psoriatic ArthritisNCT01474876AbbVie / Abbott
Safety and Effectiveness of Adalimumab (Humira) in Patients With AS in Clinical RoutineNCT01079182AbbVie / Abbott
Adalimumab (Humira) Therapy on Selected Health Care Resource Utilization and Sick Leave in Patients With AS in Clinical Practice (IDEA)NCT01754727Abbott
Belgian Registry of HUMIRA (Adalimumab) in Rheumatoid Arthritis, Psoriatic Arthritis and AS (ProAct)NCT01078558AbbVie and Veeda Clinical Research, Brussels
Remicade (Infliximab)
European AS Infliximab Cohort (EASIC) Follow up Registration Study (EASIC registry)NCT01286545Centocor Biotech and Rheumazentrum Ruhrgebiet

Clinical Trial: Drug / MedicationStudyTrial IdentifierSponsor
Ultrasound / X - Ray
Clinical and Radiographic Correlation of Ultrasound MASEI Index in Patients With ASNCT01567878University of Sao Paulo

References

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001457
2. http://www.mayoclinic.com/health/ank...ylitis/DS00483
3. http://emedicine.medscape.com/article/332945-overview
4. Spondylitis Association of America. http://www.spondylitis.org
5. Thaler KJ, Gartlehner G, Kien C, Van Noord MG, Thakurta S, Wines RCM, Hansen RA, McDonagh MS. Drug class review: Targeted immune modulator. Final update 3 report. Prepared by the RTI-UNC Evidence-based Practice Center for the Drug Effectiveness Review Project. Oregon Health & Science University. Portland, OR. 2012. Available at: http://derp.ohsu.edu/about/final-document-display.cfm

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