Abstract
Ankylosing spondylitis (AS) is a rare inflammatory disorder that affects the axial skeleton. It is characterized by inflammation of the joints of the spine with subsequent bridging of the spinal segments resulting in a reduced mobility of the spine and subsequent stiffness of the spine. It can be a severely limiting condition adversely affecting the quality of life of affected individuals. It has been found to be commoner in Caucasians and Asians but rare in blacks in the Americas with few cases reported amongst the African Black population. It is associated with the occurrence of the major histocompatibility complex (MHC) class 1 allele HLA-B27. We present the case of a 44-year-old Nigerian man presenting with a 21-year history of progressively worsening back pain and stiffness associated with hip pain and difficulty in extending his neck. He had no extraspinal manifestations. He was diagnosed with Ankylosing Spondylitis using the modified New York criteria. He was commenced on selective COX2 inhibitors and a physical therapy program aimed at improving the flexibility of the spine and reducing pain. He had a significant improvement in his pain and improved flexibility of his spine in all planes. Ankylosing spondylitis affects the axial skeleton primarily but there may be some extra spinal manifestations such as anterior uveitis, psoriasis and inflammatory bowel disease. Various modalities are employed in its treatment ranging from physical therapy, drugs e.g. Nonsteroidal anti-inflammatory drugs, tumour necrosis factor inbibitors and surgery where complications arise. These have proven effective in improving the symptoms of the disease and quality of life.
Highlights
Ankylosing spondylitis is a subtype of a group of rheumatic conditions affecting the spine known as spondyloarthritis
We present the case of a 44-yearold Nigerian man presenting with a 21-year history of progressively worsening back pain and stiffness associated with hip pain and difficulty in extending his neck
There is an inflammatory process mediated by tumour necrosis factor which results in an erosion of the bone and attempts at healing by bony spur formation, which can bridge the spine segments resulting in a fusion of adjoining segments of the spine [9]
Summary
Ankylosing spondylitis is a subtype of a group of rheumatic conditions affecting the spine known as spondyloarthritis. It is regarded as a chronic inflammatory disease affecting the spine with an autoimmune component. It has been found to be commonest in the Northern Artic countries and rare in blacks of African descent [1] [2] [3] [4] It affects men more commonly and typically the onset of the condition is within the second and third decades of life [5]. Various modalities are employed which include; physical therapy, Non-Steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs such as methotrexate and tumour necrosis factor inhibitors (TNFi).
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