Ankylosing spondylitis 491494 225801298 2008-07-15T13:47:02Z Hunnyhiteshseth 395453 /* Physical therapy */ {{DiseaseDisorder infobox | Name = Ankylosing spondylitis | ICD10 = {{ICD10|M|08|1|m|05}}, {{ICD10|M|45||m|45}} | ICD9 = {{ICD9|720.0}} | ICDO = | Image = Ankylosing.jpg | Caption = | OMIM = 106300 | MedlinePlus = 000420 | eMedicineSubj = radio | eMedicineTopic = 41| DiseasesDB = 728 | MeshID = D013167 | }} '''Ankylosing spondylitis''' ('''AS'''; also known as '''Bechterew's disease'''; '''Bechterew syndrome'''; '''Marie Strümpell disease''' / '''Marie Struempell disease''' / '''Spondyloarthritis''') is a chronic, painful, [[degenerative disease|degenerative]] inflammatory [[arthritis]] primarily affecting [[vertebral column|spine]] and [[sacroiliac joint]]s, causing eventual fusion of the spine; it is a member of the group of the [[autoimmune]] [[spondyloarthropathy|spondyloarthropathies]] with a probable genetic [[predisposition]]. Complete fusion results in a complete rigidity of the spine, a condition known as '''bamboo spine'''.<ref>{{cite journal | author = Jiménez-Balderas FJ, Mintz G. | title = Ankylosing spondylitis: clinical course in women and men | journal = J Rheumatol | volume = 20 | issue = 12 | pages = 2069–72 | year = 1993 | pmid = 7516975}}</ref> ==Signs and symptoms== The typical patient is young, of 15 to 30 years of age, with [[chronic (medicine)|chronic]] pain and stiffness in the lower part of the spine. Men are affected more than women by a [[ratio]] in excess of 2:1.<ref>[http://www.spondylitis.org/patient_resources/women.aspx Patient Resources - Women's Health<!-- Bot generated title -->]</ref> In 40% of cases, ankylosing spondylitis is associated with [[iridocyclitis]] causing eye pain and [[photophobia]] (increased sensitivity to light). Other common symptoms are recurring [[mouth ulcers]] (aphthae) and [[Fatigue (physical)|fatigue]]. Pain can fluctuate from one side to the other. Typical [[prodrome]]s (early symptoms) may occur at a very young age (e.g., 3 years old), when the patient may experience recurring painful joints (e.g. knees, elbows) commonly misinterpreted as simple rheumatism. AS is also associated with [[ulcerative colitis]], [[Crohn's disease]], [[psoriasis]], and [[Reiter's disease]]. ==Diagnosis== [[Image:Ankylosing spondylitis lumbar spine.jpg|thumb|150px|Lateral Lumbar Spine X-Ray demonstrating Ankylosing spondylitis ]] [[Image:Ankylosing process.jpg|thumb|256px|The ankylosis process.]] There is no direct test to diagnose AS. A clinical examination and [[X-ray]] studies of the spine, which show characteristic spinal changes and [[Sacroiliac joint|sacroiliitis]], are the major diagnostic tools. A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray-evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced. Options for more accurate (and much earlier) diagnosis are [[Computed tomography|tomography]] and [[magnetic resonance imaging]] of the sacroiliac joints. The [[Schober's test]] is a useful clinical measure of flexion of the lumbar spine performed during examination.<ref>{{cite journal | author = Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR. | title = Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care | journal = Spine | volume = 23 | issue = 2 | pages = 343–7 | year = 1998 | pmid = 9507623 | doi = 10.1097/00007632-199802010-00011}}</ref> During acute inflammatory periods, AS patients will usually show an increase in the blood concentration of [[C-Reactive protein|C-reactive protein]] (CRP) and an increase in the [[erythrocyte sedimentation rate]] (ESR). Variations of the HLA-B gene increase the risk of developing ankylosing spondylitis, although it is not a diagnostic test. Those with the [[HLA-B27]] variant are at a higher risk than the general population of developing the disorder. HLA-B27, demonstrated in a [[blood test]], is occasionally used as a diagnostic but does not distinguish AS from other diseases and is therefore not of real diagnostic value. Over 95% of people that have been diagnosed with AS are HLA-B27 positive, although this ratio varies from population to population (only 50% of African American patients with AS possess HLA-B27, and it is close to 80% among AS patients from Mediterranean countries). In 2007, a collaborative effort by an international team of researchers in the U.K., Australia and the United States led to the discovery of two genes, ARTS1 and [[Interleukin_23|IL23R]], that also cause AS. The findings were published in the November 2007 edition of Nature Genetics, a journal that emphasizes research on the genetic basis for common and complex diseases.<ref>Spondylitis Association of America (October 21, 2007), "[http://www.spondylitis.org/press/news/293.aspx Spondylitis Association of America Participates in Study That Uncovers Two Genes Related to Disabling Form of Arthritis]"</ref> Together with HLA-B27, these two genes account for roughly 70 percent of the overall incidence of the disease. The Bath Ankylosing Spondylitis Disease Activity Index ([[BASDAI]]), developed in [[Bath, Somerset|Bath]] (UK), is an index designed to detect the inflammatory burden of active disease. The BASDA can help to establish a diagnosis of AS in the presence of other factors such as HLA-B27 positivity, persistent buttock pain which resolves with exercise, and X-ray or MRI evident involvement of the sacroiliac joints. (See: "Diagnostic Tools", below)<ref>{{cite journal | author = Garrett S, Jenkinson T, Kennedy L, Whitelock H, Gaisford P, Calin A | title = A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index | journal = J Rheumatol | volume = 21 | issue = 12 | pages = 2286–91 | year = 1994 | pmid = 7699630}}</ref> It can be easily calculated and accurately assesses a patient's need for additional therapy; a patient with a score of 4 out of a possible 10 points while on adequate NSAID therapy is usually considered a good candidate for biologic therapy. The Bath Ankylosing Spondylitis Functional Index (BASFI) is a functional index which can accurately assess a patient's functional impairment due to the disease as well as improvements following therapy. (See: "Diagnostic Tools", below)<ref>{{cite journal | author = Calin A, Garrett S, Whitelock H, Kennedy L, O'Hea J, Mallorie P, Jenkinson T | title = A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index | journal = J Rheumatol | volume = 21 | issue = 12 | pages = 2281–5 | year = 1994 | pmid = 7699629}}</ref> The BASFI is not usually used as a diagnostic tool but rather as a tool to establish a patient's current baseline and subsequent response to therapy. ==Pathophysiology== AS is a systemic [[rheumatic]] disease and is one of the [[seronegative spondyloarthropathy|seronegative spondyloarthropathies]]. About 90% of the patients express the [[HLA-B27]] genotype. [[Tumor necrosis factor-alpha]] (TNF α) and [[IL-1]] are also implicated in ankylosing spondylitis. Although specific autoantibodies cannot be detected, its response to immunosuppresive medication has prompted its classification as an autoimmune disease. Hypotheses on its pathogenesis include a cross-reaction with antigens of the [[Klebsiella]] bacterial strain (Tiwana et al. 2001).<ref> {{cite journal | author = Tiwana H, Natt R, Benitez-Brito R, Shah S, Wilson C, Bridger S, Harbord M, Sarner M, Ebringer A | title = Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis | journal = Rheumatology (Oxford) | volume = 40 | issue = 1 | pages = 15–23 | year = 2001 | pmid = 11157137 | doi = 10.1093/rheumatology/40.1.15}}</ref> Particular authorities argue that elimination of the prime nutrients of Klebsiella (starches) would decrease antigenemia and improve the musculoskeletal symptoms. On the other hand, Khan (2002) argues that the evidence for a correlation between Klebsiella and AS is circumstantial so far, and that the efficacy of low-starch diets has not yet been scientifically evaluated.<ref>{{cite book | author=Khan MA. | year=2002 | title=Ankylosing spondylitis: The facts | publisher= Oxford University Press | id=ISBN 0-19-263282-5}}</ref> Similarly, Toivanen (1999) found no support for the role of klebsiella in the etiology of primary AS.<ref>{{cite journal | author = Toivanen P, Hansen D, Mestre F, Lehtonen L, Vaahtovuo J, Vehma M, Möttönen T, Saario R, Luukkainen R, Nissilä M | title = Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis | journal = J Clin Microbiol | volume = 37 | issue = 9 | pages = 2808–12 | year = 1999 | pmid = 10449457 | url=http://jcm.asm.org/cgi/content/full/37/9/2808?view=long&pmid=10449457}}</ref> ==Epidemiology== The sex ratio is 3:1 for men:women. In the [[USA]], the [[prevalence]] is 0.25%, but as it is a chronic condition the [[incidence (epidemiology)|incidence]] (number of new cases) is fairly low. Many rheumatologists believe the number of women with AS is underdiagnosed, as women tend to manifest symptoms in their lower spinal area (lumbar, sacrum, hips, pelvis) instead of their shoulders/upper chest/neck (where the first symptoms appear in male patients)<ref name="WomenAndAS">[http://www.spondylitis.org/patient_resources/women.aspx Patient Resources for Women], Spondylitis Association of America; retrieved [[May 26]], [[2008]].</ref>. ==History== [[Image:AS trask.jpg|thumb|256px|Leonard Trask, the Wonderful Invalid.]] It has been suggest that AS was first recognized as a disease which was different from [[rheumatoid arthritis]] by [[Galen]] as early as the second century A.D.<ref>{{cite journal | author=Dieppe P | title=Did Galen describe rheumatoid arthritis? | journal=Annals of the Rheumatic Diseases | year=1988 | volume=47 | pages=84–87}}</ref>; however, skeletal evidence of the disease (ossification of joints and entheses primarily of the [[axial skeleton]], known as "bamboo spine") was first discovered in an archaeological dig that unearthed the skeletal remains of a 5000-year–old Egyptian mummy with evidence of "bamboo spine".<ref>{{cite journal | author=Calin A. | title=Ankylosing spondilitis | journal=Clinics in Rheumatic Diseases | year=1985 | volume=11 | pages=41–60}}</ref> The anatomist and surgeon [[Realdo Colombo]] described what could have been the disease in 1559,<ref>{{cite journal | author=Pierre Marie | title=Benoist M. - Historical Perspective | journal= Spine | year=1995 | volume=20 | pages=849–852}}</ref>, and the first account of pathologic changes to the [[skeleton]] possibly associated with AS was published in 1691 by [[Bernard Connor]].<ref>{{cite journal | author=Blumberg BS | title=? | journal=Arch Rheum | year=1958 | volume=1 | pages=553 | doi=10.1002/art.1780010609}}</ref> In 1818, [[Sir Benjamin Collins Brodie, 1st Baronet|Benjamin Brodie]] became the first physician to document that a patient believed to have active AS had accompanying [[iritis]].<ref>{{cite journal | author = Leden I | title = Did Bechterew describe the disease which is named after him? A question raised due to the centennial of his primary report | journal = Scand J Rheumatol | volume = 23 | issue = 1 | pages = 42–5 | year = 1994 | pmid = 8108667 | doi = 10.3109/03009749409102134}}</ref> In 1858, [[David Tucker]] published a small booklet which clearly described a patient by the name of [[Leonard Trask]] who suffered from severe spinal deformity subsequent to AS.<ref>{{cite web | title=Life and sufferings of Leonard Trask | url=http://www.asimllc.com/members/life%20and%20sufferings%20of%20leonard%20trask.pdf | format=PDF for registered members) | publisher=Ankylosing Spondylitis Information Matrix}}</ref><ref>{{cite web | title=Life and sufferings of Leonard Trask | url=http://www.showhistory.com/TraskLeonard.handicapped.html}}</ref> In 1833 Trask fell from a horse, exacerbating the condition and resulting in severe deformity. Tucker reported: {{cquote|It was not until he [Trask] had exercised for some time that he could perform any labor [..., and that] his neck and back have continued to curve drawing his head downward on his breast.}} This account became the first documented case of AS in the United States, since its indisputable description of inflammatory disease characteristics of AS, and the hallmark of deforming injury in AS. It was not until the late nineteenth century (1893-1898), however, when the [[neurophysiologist]] [[Vladimir Bekhterev]] of Russia in 1893,<ref>{{cite journal | author=Bechterew W. | title=Steifigkeit der Wirbelsaule und ihre Verkrummung als besondere Erkrankungsform | journal=Neurol Centralbl | year=1893 | volume=12 | pages=426–434}}</ref> [[Adolph Strümpell]] of Germany in 1897,<ref>{{cite journal | author=Strumpell A. | title=Bemerkung uber die chronische ankylosirende Entzundung der Wirbelsaule und der Huftgelenke | journal=Dtsch Z Nervenheilkd | year=1897 | volume=11 | pages=338–342 | doi=10.1007/BF01674127}}</ref> and [[Pierre Marie]] of France in 1898,<ref>{{cite journal | author=Marie P. | title=Sur la spondylose rhizomelique | journal=Rev Med | year=1898 | volume=18 | pages=285–315}}</ref> were the first to give adequate descriptions which permitted an accurate diagnosis of AS prior to severe spinal deformity. For this reason, AS is also known as Bechterew Disease or Marie–Strümpel Disease. ==Prognosis== AS can range from mild to progressively debilitating and from medically controlled to refractive. Unattended cases of AS normally lead to knee pain and may be accompanied by [[dactylitis]] or [[enthesitis]], which may result in a misdiagnosis of normal rheumatism. In a long-term undiagnosed period, [[osteopenia]] or [[osteoporosis]] of the AP spine may occur, causing eventual compression fractures and a back "hump" if untreated. Typical signs of progressed AS are the visible formation of [[syndesmophyte]]s on X-rays and abnormal bone outgrowths similar to [[osteophyte]]s affecting the spine. The fusion of the vertebrae [[paresthesia]] is a complication due to the inflammation of the tissue surrounding nerves. Organs commonly affected by AS, other than the axial [[vertebral column|spine]] and other joints, are the [[heart]], [[lung]]s, [[Colon (anatomy)|colon]], and [[kidney]]. Other complications are [[aortic regurgitation]], [[Achilles tendinitis]], [[Heart block|AV node block]] and [[amyloidosis]].<ref name="Alpert">{{cite book |title=The AHA Clinical Cardiac Consult |last=Alpert |first=Joseph S. |year=2006 |publisher=Lippincott Williams & Wilkins |isbn=0781764904 }}</ref> Owing to lung fibrosis, [[chest X-rays]] may show apical fibrosis while [[pulmonary function testing]] may reveal a restrictive lung defect. Very rare complications involve [[neurology|neurologic]] conditions such as the [[cauda equina syndrome]].<ref>{{cite journal | author = Nicholas U. Ahn, Uri M. Ahn, Elizabeth S. Garrett et al. | title = Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments | journal = J of Spinal Disorders | volume = 14 | issue = 5 | pages = 427–433 | year = 2001 | pmid = 11586143 | doi = 10.1097/00002517-200110000-00009}}</ref><ref name="Alpert" /> ==Therapy== No cure is known for AS, although treatments and medications are available to reduce symptoms and pain. Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosing spondylitis. Physiotherapy and physical exercises are clearly to be preceded by medical treatment in order to reduce the inflammation and pain and are commonly followed by a physician. This way the movements will help in diminishing pain and stiffness, while exercise in an active inflammatory state will just make the pain worse. Medical professionals and experts in AS have widely speculated that maintaining good posture can reduce the likelihood of a fused or curved spine which occurs in a significant percentage of diagnosed persons. <ref>{{cite web | title=www.arthritis.org | work=Anklylosing Spondylitis Understanding its caused, Diagnosis And Treatment | url=http://arthritis.com| Patients who are able to do so lie flat on their face or back on the floor for a prescribed cumulative period of time each week to prevent the chronic stooping which may otherwise result.}}</ref><ref>{{cite web | title=Remicade.com | work=Living with Ankylosing Spondylitis | url=http://www.remicade.com/remicade/as/as_index.html | accessdate=2007-12-30}}</ref> ===Medication=== There are three major types of medications used to treat ankylosing spondylitis. * [[Anti-inflammatory|Anti-inflammatory drugs]], which include [[Non-steroidal anti-inflammatory drug|NSAID]]s such as [[aspirin]], [[ibuprofen]], [[indometacin]], [[naproxen]] and [[COX-2 inhibitor]]s, which reduce inflammation, and consequently pain. These drugs tend to have a personal response to the pain and inflammation, although commonly used anti-inflammatory drugs like [[nimesulide]] are less effective than others. [[Opioid|Opioid analgesics]] have also been proven by clinical evidence to be very effective in alleviating the type of chronic pain commonly experienced by those suffering from AS, especially in low dose time-release formulations. While NSAIDs should generally be tried first, the use of opioid analgesics either apart from or in concert with NSAIDs should not be summarily dismissed for fear of addiction, as studies have shown that patients who properly take opioid analgesics for pain rarely suffer from addiction as a result of using such opioid therapy for pain relief purposes. * [[Disease-modifying antirheumatic drug|DMARD]]s such as [[cyclosporin]], [[methotrexate]], [[sulfasalazine]], and [[corticosteroids]], used to reduce the immune system response through [[immunosuppression]]; * [[Tumor necrosis factor-alpha|TNFα]] blockers ([[antagonists]]) such as [[etanercept]], [[infliximab]] and [[adalimumab]] (also known as biologics), are indicated for the treatment of and are effective [[immunosuppression|immunosuppressant]]s in AS as in other autoimmune diseases; [[Tumor necrosis factor-alpha|TNFα]] blockers have been shown to be the most promising treatment, slowing the progress of AS in the majority of clinical cases. They have also been shown to be highly effective in treating not only the arthritis of the joints but also the spinal arthritis associated with AS. A drawback is the fact that these drugs increase the risk of infections. For this reason, the protocol for any of the TNF-α blockers include a test for [[tubercolosis]] (like [[Mantoux test|Mantoux]] or [[Heaf test|Heaf]]) before starting treatment. In case of recurrent infections, even recurrent [[pharyngitis|sore throats]], the therapy may be suspended because of the involved [[immunosuppression]]. ===Surgery=== In severe cases of AS, [[surgery]] can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky. In addition, AS can have some manifestations which make anaesthesia more complex. Changes in the upper airway can lead to difficulties in intubating the airway, spinal and epidural anaesthesia may be difficult owing to calicification of ligaments, and a small number have aortic regurgitation. The stiffness of the thoracic ribs results in ventilation being mainly diaphragm-driven, so there may be a decrease in pulmonary function. ===Physical therapy=== All physical therapies must be approved in advance by a rheumatologist, since movements that normally have great benefits to one's health may harm a patient with AS; massages and physical manipulations should be practiced by therapists familiar with this disease. Some of the therapies that have been shown to benefit AS patients include: * [[Physical therapy]]/[[Physiotherapy]], shown to be of great benefit to AS patients; * [[Swimming]], one of the preferred exercises since it involves all muscles and joints in a low gravity environment; * Slow movement muscle extending exercises like [[stretching]], [[yoga]], [[tai chi]], [[Pilates|Pilates method]], etc. Moderate-to-high impact exercises like [[jogging]] are generally not recommended or recommended with restrictions due to the jarring of affected vertabrae that can worsen pain and stiffness in some patients. ===Alternative medicine=== Although the effectiveness of alternative medicines has not been proved by any [[clinical trial]], some patients find some relief in adding these alternative treatments to the medicaments and physical exercises, such as a [[starch]]-free [[diet (nutrition)|diet]]<ref>{{cite journal | author = Ebringer A, Wilson C | title = The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis | journal = Clin Rheumatol | volume = 15 Suppl 1 | issue = | pages = 62–66 | year = 1996 | month = Jan 15 | pmid = 8835506}}</ref> (also known as the No Starch Diet or NSD).<ref>[http://www.kickas.org/ubbthreads/postlist.php?Board=starch 'No Starch Diet' Post List]</ref><ref name=KickAS>{{cite web | url = http://www.kickas.org/londondiet.shtml | title = The London AS Diet | accessdate = 2008-01-18 | last = Ebringer | first = Alan | year = 1996 | publisher = Kick AS | quote = Low starch/high protein diet for ankylosing spondylitis patients. }}</ref><ref name=sinclair>{{cite book | last = Sinclair | first = Carol | title = The IBS Low-Starch Diet | origyear = 2000 | accessyear = 2008 | publisher = Vermilion | location = UK: London | isbn = 9780091912864 | pages = pp. 23-35 }}</ref> Some patients may find relief from [[acupuncture]] treatments. This is administered at various points directly on the spine where the pain is located, although efficacy is uncertain. Herbal medicine may also relieve pain.<ref name=nih>{{cite web | url = http://www.nlm.nih.gov/medlineplus/ankylosingspondylitis.html | title = Ankylosing Spondylitis | accessdate = 2008-01-18 | year = 2008 | publisher = Medline: Nat. Inst. Health }}</ref> ==Famous persons afflicted with AS== <!---all need footnotes to show that they had AS. This footnote can be copied from their article if it is in there. All articles are standalone and ALL need their OWN footnotes. If not, add the footnote and AS line there and the footnote here---> Well known sufferers of AS include: * Taiwanese musician [[Jay Chou]]; * [[Mötley Crüe]]'s guitarist [[Mick Mars]]; * Former England [[cricket]] captain [[Mike Atherton]]; * Former Australian cricketer [[Michael Slater]]; * British comedian [[Lee Hurst (comedian)|Lee Hurst]]; * Canadian radio personality Mike Stafford; * Former Canadian radio personality Dave MacDonald; * Norwegian Prime Minister [[Jens Stoltenberg]]{{Fact|date=June 2008}} * Norwegian actor [[Ole-Jørgen Nilsen]]{{Fact|date=June 2008}} * World Chess Champion [[Vladimir Kramnik]]<ref>[http://www.chessbase.com/newsdetail.asp?newsid=2846 ChessBase.com - Chess News - Kramnik drops out of Wijk Super-Tournament]</ref> * Former author and "Saturday Review" editor [[Norman Cousins]];<ref>Cousins wrote a bestselling book about his illness,''Anatomy of an Illness''. But since he was "cured" of the disease, which is incurable, he may have been misdiagnosed.</ref> * Scottish former snooker player [[Chris Small]]; * Former US Major League baseball player [[Rico Brogna]]; * [[Ed Sullivan]], the Ed Sullivan Show, US{{Fact|date=June 2008}} * Czech writer [[Karel Čapek]]<ref>{{cite journal | author = Trnavsky K., Sabova L. | title = Karel Capek-Czech writer, sufferer from ankylosing spondylitis | journal = Clin Rheumatol. | volume = 11 | issue = 3 | pages = 337–40 | year = 1992 | pmid = 1458780 | doi = 10.1007/BF02207189}}</ref>; * British golfer [[Ian Woosnam]]; * Hong Kong Actress [[Ada Choi]]. ==Additional images== <gallery> Image:Morbus Bechterew.jpg|Morbus Bechterew Image:M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg|MRI of SI joints </gallery> ==See also== * [[North American Spondylitis Consortium|NASC]], North American AS federation * [[NIAMS]], the National Institute of Arthritis and Musculoskeletal and Skin Diseases * [[Spondylitis Association of America|SAA]], Spondylitis Association of America * [[Arthritis Foundation|AF]], Arthritis Foundation ==References== {{Reflist|2}} ==External links== * {{DMOZ|Health/Conditions_and_Diseases/Musculoskeletal_Disorders/Arthritis/Ankylosing_Spondylitis/}} ===Diagnostic tools=== *[http://www.basdai.com/BASDAI.php Bath Ankylosing Spondylitis Disease Activity Index Calculator] (BASDAI) *[http://www.basdai.com/BASFI.php Bath Ankylosing Spondylitis Functional Index Calculator] (BASFI) ===Current research=== *[http://ankylosingspondylitis.researchtoday.net/ Ankylosing Spondylitis Research] (Recent primary literature) {{Diseases of the musculoskeletal system and connective tissue}} [[Category:Arthritis]] [[Category:Autoimmune diseases]] {{Link FA|de}} [[cs:Bechtěrevova nemoc]] [[de:Spondylitis ankylosans]] [[es:Espondilitis anquilosante]] [[fi:Selkärankareuma]] [[fr:Spondylarthrite ankylosante]] [[it:Spondilite anchilosante]] [[he:דלקת חוליות מקשחת]] [[nl:Ziekte van Bechterew]] [[no:Bekhterevs sykdom]] [[pl:Zesztywniające zapalenie stawów kręgosłupa]] [[ru:Анкилозирующий спондилит]] [[sv:Ankyloserande spondylit]] [[tr:Ankilozan spondilit]] [[zh:强直性脊柱炎]]