Ankylosing Spondylitis: Diagnosis and Management

The first and only interdisciplinary guide dedicated to the subject, this reference leads readers through the pathogenic, genetic, clinical, and biomechanical aspects of ankylosing spondylitis (AS) and addresses issues related to outcomes assessment, medical treatment, surgical complications, disease management, and genetics.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing pain, stiffness, and a progressive thoracolumbar kyphotic deformity. In about one-third of the patients, peripheral joints are also affected. The aim of treatment is reduction of pain and stiffness, and to prevent a thoracolumbar kyphotic deformity or at least to minimize progression. Current conservative therapy consists of exercise programs and medical treatment, including nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. Recently, biologicals (anti-tumor necrosis factor-a drugs) proved to be very effective in the treatment of ankylosing spondylitis. Most patients can be treated successfully with these conservative treatment modalities. A small group of patients, however, do develop a severe thoracolumbar or cervical kyphotic deformity. In these patients, corrective osteotomy of the spine may be considered. These osteotomies proved to be advantageous for numerous patients. However, occasional poor results and complications have diminished their acceptance by rheumatologists and orthopedic surgeons. This is not surprising, because there are still many unsolved questions concerning pre- and postoperative assessment of the deformity, and surgical procedures.