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<span>Pathophysiology</span> </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Imaging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Imaging"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Imaging</span> </div> </a> <ul id="toc-Imaging-sublist" class="vector-toc-list"> <li id="toc-X-rays" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#X-rays"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.1</span> <span>X-rays</span> </div> </a> <ul id="toc-X-rays-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Blood_parameters" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Blood_parameters"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Blood parameters</span> </div> </a> <ul id="toc-Blood_parameters-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genetic_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genetic_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Genetic testing</span> </div> </a> <ul id="toc-Genetic_testing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-BASDAI" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#BASDAI"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>BASDAI</span> </div> </a> <ul id="toc-BASDAI-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Children" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.5</span> <span>Children</span> </div> </a> <ul id="toc-Children-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Schober's_test" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Schober's_test"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.6</span> <span>Schober's test</span> </div> </a> <ul id="toc-Schober's_test-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Medication</span> </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> <li id="toc-NSAIDs" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#NSAIDs"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.1</span> <span>NSAIDs</span> </div> </a> <ul id="toc-NSAIDs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-TNF_inhibitors" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#TNF_inhibitors"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.2</span> <span>TNF inhibitors</span> </div> </a> <ul id="toc-TNF_inhibitors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Non-TNFi_biologics" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Non-TNFi_biologics"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.3</span> <span>Non-TNFi biologics</span> </div> </a> <ul id="toc-Non-TNFi_biologics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Biosimilar_drugs" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Biosimilar_drugs"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.4</span> <span>Biosimilar drugs</span> </div> </a> <ul id="toc-Biosimilar_drugs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-csARDs" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#csARDs"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.5</span> <span>csARDs</span> </div> </a> <ul id="toc-csARDs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Corticosteroids" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Corticosteroids"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.6</span> <span>Corticosteroids</span> </div> </a> <ul id="toc-Corticosteroids-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Physical_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Physical_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Physical therapy</span> </div> </a> <ul id="toc-Physical_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diet" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diet"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Diet</span> </div> </a> <ul id="toc-Diet-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prognosis</span> </div> </a> <button aria-controls="toc-Prognosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prognosis subsection</span> </button> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> <li id="toc-Mortality" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mortality"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Mortality</span> </div> </a> <ul id="toc-Mortality-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gait" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Gait"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Gait</span> </div> </a> <ul id="toc-Gait-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Ankylosing spondylitis</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 54 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-54" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">54 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D9%84%D8%AA%D9%87%D8%A7%D8%A8_%D8%A7%D9%84%D9%81%D9%82%D8%A7%D8%B1_%D8%A7%D9%84%D9%85%D9%82%D8%B3%D8%B7" title="التهاب الفقار المقسط – Arabic" lang="ar" hreflang="ar" data-title="التهاب الفقار المقسط" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%A2%D9%86%DA%A9%D9%88%D9%84%D9%88%D8%B2%DB%8C%D9%86%DA%AF_%D8%A7%DB%8C%D8%B3%D9%BE%D9%88%D9%86%D8%AF%DB%8C%D9%84%DB%8C%D8%AA" title="آنکولوزینگ ایسپوندیلیت – South Azerbaijani" lang="azb" hreflang="azb" data-title="آنکولوزینگ ایسپوندیلیت" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%8F%E0%A6%99%E0%A7%8D%E0%A6%95%E0%A6%BE%E0%A6%87%E0%A6%B2%E0%A7%8B%E0%A6%9C%E0%A6%BF%E0%A6%82_%E0%A6%B8%E0%A7%8D%E0%A6%AA%E0%A6%A8%E0%A7%8D%E0%A6%A1%E0%A6%BE%E0%A6%87%E0%A6%B2%E0%A6%BE%E0%A6%87%E0%A6%9F%E0%A6%BF%E0%A6%B8" title="এঙ্কাইলোজিং স্পন্ডাইলাইটিস – Bangla" lang="bn" hreflang="bn" data-title="এঙ্কাইলোজিং স্পন্ডাইলাইটিস" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%90%D0%BD%D0%BA%D0%B8%D0%BB%D0%BE%D0%B7%D0%B8%D1%80%D0%B0%D1%89_%D1%81%D0%BF%D0%BE%D0%BD%D0%B4%D0%B8%D0%BB%D0%B8%D1%82" title="Анкилозиращ спондилит – Bulgarian" lang="bg" hreflang="bg" data-title="Анкилозиращ спондилит" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Ankiloziraju%C4%87i_spondilitis" title="Ankilozirajući spondilitis – Bosnian" lang="bs" hreflang="bs" data-title="Ankilozirajući spondilitis" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Espondiloartritis_anquilosant" title="Espondiloartritis anquilosant – Catalan" lang="ca" hreflang="ca" data-title="Espondiloartritis anquilosant" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cv mw-list-item"><a href="https://cv.wikipedia.org/wiki/%D0%91%D0%B5%D1%85%D1%82%D0%B5%D1%80%D0%B5%D0%B2_%D0%B0%D0%BC%D0%B0%D0%BA%C4%95" title="Бехтерев амакĕ – Chuvash" lang="cv" hreflang="cv" data-title="Бехтерев амакĕ" data-language-autonym="Чӑвашла" data-language-local-name="Chuvash" class="interlanguage-link-target"><span>Чӑвашла</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Becht%C4%9Brevova_nemoc" title="Bechtěrevova nemoc – Czech" lang="cs" hreflang="cs" data-title="Bechtěrevova nemoc" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Bechterews_sygdom" title="Bechterews sygdom – Danish" lang="da" hreflang="da" data-title="Bechterews sygdom" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://de.wikipedia.org/wiki/Spondylitis_ankylosans" title="Spondylitis ankylosans – German" lang="de" hreflang="de" data-title="Spondylitis ankylosans" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Liigesej%C3%A4ikuslik_l%C3%BClip%C3%B5letik" title="Liigesejäikuslik lülipõletik – Estonian" lang="et" hreflang="et" data-title="Liigesejäikuslik lülipõletik" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%91%CE%B3%CE%BA%CF%85%CE%BB%CE%BF%CF%80%CE%BF%CE%B9%CE%B7%CF%84%CE%B9%CE%BA%CE%AE_%CF%83%CF%80%CE%BF%CE%BD%CE%B4%CF%85%CE%BB%CE%BF%CE%B1%CF%81%CE%B8%CF%81%CE%AF%CF%84%CE%B9%CE%B4%CE%B1" title="Αγκυλοποιητική σπονδυλοαρθρίτιδα – Greek" lang="el" hreflang="el" data-title="Αγκυλοποιητική σπονδυλοαρθρίτιδα" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Espondilitis_anquilosante" title="Espondilitis anquilosante – Spanish" lang="es" hreflang="es" data-title="Espondilitis anquilosante" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Ankiloza_spondilito" title="Ankiloza spondilito – Esperanto" lang="eo" hreflang="eo" data-title="Ankiloza spondilito" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Espondilitis_ankilosatzaile" title="Espondilitis ankilosatzaile – Basque" lang="eu" hreflang="eu" data-title="Espondilitis ankilosatzaile" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%D9%BE%D9%88%D9%86%D8%AF%DB%8C%D9%84%DB%8C%D8%AA_%D8%A2%D9%86%DA%A9%DB%8C%D9%84%D9%88%D8%B2%D8%A7%D9%86" title="اسپوندیلیت آنکیلوزان – Persian" lang="fa" hreflang="fa" data-title="اسپوندیلیت آنکیلوزان" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Spondylarthrite_ankylosante" title="Spondylarthrite ankylosante – French" lang="fr" hreflang="fr" data-title="Spondylarthrite ankylosante" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Spondail%C3%ADteas_ancal%C3%B3saithe" title="Spondailíteas ancalósaithe – Irish" lang="ga" hreflang="ga" data-title="Spondailíteas ancalósaithe" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B0%95%EC%A7%81%EC%84%B1_%EC%B2%99%EC%A3%BC%EC%97%BC" title="강직성 척주염 – Korean" lang="ko" hreflang="ko" data-title="강직성 척주염" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%B1%D5%B6%D5%AF%D5%AB%D5%AC%D5%B8%D5%A6%D5%A1%D6%81%D5%B6%D5%B8%D5%B2_%D5%BD%D5%BA%D5%B8%D5%B6%D5%A4%D5%AB%D5%AC%D5%B8%D5%A1%D6%80%D5%A9%D6%80%D5%AB%D5%BF" title="Անկիլոզացնող սպոնդիլոարթրիտ – Armenian" lang="hy" hreflang="hy" data-title="Անկիլոզացնող սպոնդիլոարթրիտ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%85%E0%A4%9A%E0%A4%B2%E0%A4%A4%E0%A4%BE%E0%A4%95%E0%A4%BE%E0%A4%B0%E0%A4%95_%E0%A4%95%E0%A4%B6%E0%A5%87%E0%A4%B0%E0%A5%82%E0%A4%95%E0%A4%BE%E0%A4%B6%E0%A5%8B%E0%A4%A5" title="अचलताकारक कशेरूकाशोथ – Hindi" lang="hi" hreflang="hi" data-title="अचलताकारक कशेरूकाशोथ" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Ankilosing_spodilitis" title="Ankilosing spodilitis – Indonesian" lang="id" hreflang="id" data-title="Ankilosing spodilitis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Hryggikt" title="Hryggikt – Icelandic" lang="is" hreflang="is" data-title="Hryggikt" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Spondilite_anchilosante" title="Spondilite anchilosante – Italian" lang="it" hreflang="it" data-title="Spondilite anchilosante" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%93%D7%9C%D7%A7%D7%AA_%D7%97%D7%95%D7%9C%D7%99%D7%95%D7%AA_%D7%9E%D7%A7%D7%A9%D7%97%D7%AA" title="דלקת חוליות מקשחת – Hebrew" lang="he" hreflang="he" data-title="דלקת חוליות מקשחת" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ku mw-list-item"><a href="https://ku.wikipedia.org/wiki/Nexwe%C5%9Fiya_Bechterew" title="Nexweşiya Bechterew – Kurdish" lang="ku" hreflang="ku" data-title="Nexweşiya Bechterew" data-language-autonym="Kurdî" data-language-local-name="Kurdish" class="interlanguage-link-target"><span>Kurdî</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%A1%D0%BF%D0%BE%D0%BD%D0%B4%D0%B8%D0%BB%D0%BE%D0%B0%D1%80%D1%82%D1%80%D0%B8%D1%82" title="Спондилоартрит – Kyrgyz" lang="ky" hreflang="ky" data-title="Спондилоартрит" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Spondylosis_ankylosans" title="Spondylosis ankylosans – Latin" lang="la" hreflang="la" data-title="Spondylosis ankylosans" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lfn mw-list-item"><a href="https://lfn.wikipedia.org/wiki/Spondilite_ancilosante" title="Spondilite ancilosante – Lingua Franca Nova" lang="lfn" hreflang="lfn" data-title="Spondilite ancilosante" data-language-autonym="Lingua Franca Nova" data-language-local-name="Lingua Franca Nova" class="interlanguage-link-target"><span>Lingua Franca Nova</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Bechterew-k%C3%B3r" title="Bechterew-kór – Hungarian" lang="hu" hreflang="hu" data-title="Bechterew-kór" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%AE%E0%A4%A3%E0%A4%95%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%9A%E0%A5%80_%E0%A4%9D%E0%A4%BF%E0%A4%9C" title="मणक्याची झिज – Marathi" lang="mr" hreflang="mr" data-title="मणक्याची झिज" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target"><span>मराठी</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Ziekte_van_Bechterew" title="Ziekte van Bechterew – Dutch" lang="nl" hreflang="nl" data-title="Ziekte van Bechterew" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%BC%B7%E7%9B%B4%E6%80%A7%E8%84%8A%E6%A4%8E%E7%82%8E" title="強直性脊椎炎 – Japanese" lang="ja" hreflang="ja" data-title="強直性脊椎炎" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Bekhterevs_sykdom" title="Bekhterevs sykdom – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Bekhterevs sykdom" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%86%E0%AC%99%E0%AD%8D%E0%AC%95%E0%AC%BF%E0%AC%B2%E0%AD%8B%E0%AC%9C%E0%AC%BF%E0%AC%99%E0%AD%8D%E0%AC%97_%E0%AC%B8%E0%AD%8D%E0%AC%AA%E0%AD%8B%E0%AC%A3%E0%AD%8D%E0%AC%A1%E0%AC%BF%E0%AC%B2%E0%AC%BE%E0%AC%87%E0%AC%9F%E0%AC%BF%E0%AC%B8" title="ଆଙ୍କିଲୋଜିଙ୍ଗ ସ୍ପୋଣ୍ଡିଲାଇଟିସ – Odia" lang="or" hreflang="or" data-title="ଆଙ୍କିଲୋଜିଙ୍ଗ ସ୍ପୋଣ୍ଡିଲାଇଟିସ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Zesztywniaj%C4%85ce_zapalenie_staw%C3%B3w_kr%C4%99gos%C5%82upa" title="Zesztywniające zapalenie stawów kręgosłupa – Polish" lang="pl" hreflang="pl" data-title="Zesztywniające zapalenie stawów kręgosłupa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Espondilite_anquilosante" title="Espondilite anquilosante – Portuguese" lang="pt" hreflang="pt" data-title="Espondilite anquilosante" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%91%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D1%8C_%D0%91%D0%B5%D1%85%D1%82%D0%B5%D1%80%D0%B5%D0%B2%D0%B0" title="Болезнь Бехтерева – Russian" lang="ru" hreflang="ru" data-title="Болезнь Бехтерева" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Ankylosing_spondylitis" title="Ankylosing spondylitis – Simple English" lang="en-simple" hreflang="en-simple" data-title="Ankylosing spondylitis" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Ankylozuj%C3%BAca_spondylit%C3%ADda" title="Ankylozujúca spondylitída – Slovak" lang="sk" hreflang="sk" data-title="Ankylozujúca spondylitída" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Ankilozirajo%C4%8Di_spondilitis" title="Ankilozirajoči spondilitis – Slovenian" lang="sl" hreflang="sl" data-title="Ankilozirajoči spondilitis" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://sr.wikipedia.org/wiki/%D0%90%D0%BD%D0%BA%D0%B8%D0%BB%D0%BE%D0%B7%D0%B8%D1%80%D0%B0%D1%98%D1%83%D1%9B%D0%B8_%D1%81%D0%BF%D0%BE%D0%BD%D0%B4%D0%B8%D0%BB%D0%B8%D1%82%D0%B8%D1%81" title="Анкилозирајући спондилитис – Serbian" lang="sr" hreflang="sr" data-title="Анкилозирајући спондилитис" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Ankiloziraju%C4%87i_spondilitis" title="Ankilozirajući spondilitis – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Ankilozirajući spondilitis" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Selk%C3%A4rankareuma" title="Selkärankareuma – Finnish" lang="fi" hreflang="fi" data-title="Selkärankareuma" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Ankyloserande_spondylit" title="Ankyloserande spondylit – Swedish" lang="sv" hreflang="sv" data-title="Ankyloserande spondylit" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%AE%E0%AE%9F%E0%AE%99%E0%AF%8D%E0%AE%95%E0%AE%BE%E0%AE%A4%E0%AE%A8%E0%AE%BF%E0%AE%B2%E0%AF%88_%E0%AE%AE%E0%AF%81%E0%AE%A4%E0%AF%81%E0%AE%95%E0%AF%86%E0%AE%B2%E0%AF%81%E0%AE%AE%E0%AF%8D%E0%AE%AA%E0%AF%81_%E0%AE%B5%E0%AF%80%E0%AE%95%E0%AF%8D%E0%AE%95%E0%AE%AE%E0%AF%8D" title="மடங்காதநிலை முதுகெலும்பு வீக்கம் – Tamil" lang="ta" hreflang="ta" data-title="மடங்காதநிலை முதுகெலும்பு வீக்கம்" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%90%D0%BD%D0%BA%D0%B8%D0%BB%D0%BE%D0%B7%D0%BB%D0%B0%D1%83%D1%87%D1%8B_%D1%81%D0%BF%D0%BE%D0%BD%D0%B4%D0%B8%D0%BB%D0%B8%D1%82" title="Анкилозлаучы спондилит – Tatar" lang="tt" hreflang="tt" data-title="Анкилозлаучы спондилит" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target"><span>Татарча / tatarça</span></a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%86%E0%B0%82%E0%B0%95%E0%B0%BF%E0%B0%B2%E0%B1%8B%E0%B0%9C%E0%B0%BF%E0%B0%82%E0%B0%97%E0%B1%8D_%E0%B0%B8%E0%B1%8D%E0%B0%AA%E0%B0%BE%E0%B0%82%E0%B0%A1%E0%B0%BF%E0%B0%B2%E0%B1%88%E0%B0%9F%E0%B0%BF%E0%B0%B8%E0%B1%8D" title="ఆంకిలోజింగ్ స్పాండిలైటిస్ – Telugu" lang="te" hreflang="te" data-title="ఆంకిలోజింగ్ స్పాండిలైటిస్" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target"><span>తెలుగు</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%A3%E0%B8%B0%E0%B8%94%E0%B8%B9%E0%B8%81%E0%B8%AA%E0%B8%B1%E0%B8%99%E0%B8%AB%E0%B8%A5%E0%B8%B1%E0%B8%87%E0%B8%AD%E0%B8%B1%E0%B8%81%E0%B9%80%E0%B8%AA%E0%B8%9A%E0%B8%A2%E0%B8%B6%E0%B8%94%E0%B8%95%E0%B8%B4%E0%B8%94" title="กระดูกสันหลังอักเสบยึดติด – Thai" lang="th" hreflang="th" data-title="กระดูกสันหลังอักเสบยึดติด" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Ankilozan_spondilit" title="Ankilozan spondilit – Turkish" lang="tr" hreflang="tr" data-title="Ankilozan spondilit" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%90%D0%BD%D0%BA%D1%96%D0%BB%D0%BE%D0%B7%D1%83%D1%8E%D1%87%D0%B8%D0%B9_%D1%81%D0%BF%D0%BE%D0%BD%D0%B4%D0%B8%D0%BB%D0%BE%D0%B0%D1%80%D1%82%D1%80%D0%B8%D1%82" title="Анкілозуючий спондилоартрит – Ukrainian" lang="uk" hreflang="uk" data-title="Анкілозуючий спондилоартрит" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-ug mw-list-item"><a href="https://ug.wikipedia.org/wiki/%D9%82%D8%A7%D8%AA%D9%85%D8%A7_%D8%AE%D8%A7%D8%B1%D8%A7%D9%83%D8%AA%DB%90%D8%B1%D9%84%D9%89%D9%83_%D8%A6%D9%88%D9%85%DB%87%D8%B1%D8%AA%D9%82%D8%A7_%D9%8A%D8%A7%D9%84%D9%84%DB%87%D8%BA%D9%89" title="قاتما خاراكتېرلىك ئومۇرتقا ياللۇغى – Uyghur" lang="ug" hreflang="ug" data-title="قاتما خاراكتېرلىك ئومۇرتقا ياللۇغى" data-language-autonym="ئۇيغۇرچە / Uyghurche" data-language-local-name="Uyghur" class="interlanguage-link-target"><span>ئۇيغۇرچە / 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class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Type of arthritis of the spine</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Ankylosing spondylitis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Bekhterev's disease, Bechterew's disease, morbus Bechterew, Bekhterev–Strümpell–Marie disease, Marie's disease, Marie–Strümpell arthritis, Pierre–Marie's disease<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:0510_Spondylitis_ankylosans_(morbus_bechterew)_anagoria.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a8/0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG/220px-0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG" decoding="async" width="220" height="512" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a8/0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG/330px-0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a8/0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG/440px-0510_Spondylitis_ankylosans_%28morbus_bechterew%29_anagoria.JPG 2x" data-file-width="2040" data-file-height="4750" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">A 6th-century skeleton showing fused <a href="/wiki/Vertebrae" class="mw-redirect" title="Vertebrae">vertebrae</a>, a sign of severe ankylosing spondylitis</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Back_pain" title="Back pain">Back pain</a>, joint stiffness<sup id="cite_ref-NIH2016_2-0" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">Eye inflammation (uveitis), Compression fractures, Heart problems.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Young adulthood<sup id="cite_ref-NIH2016_2-1" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Lifetime<sup id="cite_ref-NIH2016_2-2" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Unknown<sup id="cite_ref-NIH2016_2-3" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Symptoms, <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a> and blood tests<sup id="cite_ref-NIH2016_2-4" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Medication, physical therapy</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/NSAIDs" class="mw-redirect" title="NSAIDs">NSAIDs</a>, <a href="/wiki/Corticosteroids" class="mw-redirect" title="Corticosteroids">steroids</a>, <a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">DMARDs</a>,<sup id="cite_ref-NIH2016_2-5" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> TNF Inhibitor</td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">0.1 to 0.8%<sup id="cite_ref-Kh2009_4-0" class="reference"><a href="#cite_note-Kh2009-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Ankylosing spondylitis</b> (<b>AS</b>) is a type of <a href="/wiki/Arthritis" title="Arthritis">arthritis</a> from the disease spectrum of <a href="/wiki/Axial_spondyloarthritis" title="Axial spondyloarthritis">axial spondyloarthritis</a>.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> It is characterized by long-term <a href="/wiki/Inflammation" title="Inflammation">inflammation</a> of the <a href="/wiki/Joints" class="mw-redirect" title="Joints">joints</a> of the <a href="/wiki/Vertebral_column" title="Vertebral column">spine</a>, typically where the spine joins the pelvis.<sup id="cite_ref-NIH2016_2-6" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> With AS, eye and <a href="/wiki/Gastrointestinal_tract" title="Gastrointestinal tract">bowel</a> problems—as well as back pain—may occur.<sup id="cite_ref-NIH2016_2-7" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Joint mobility in the affected areas sometimes worsens over time.<sup id="cite_ref-NIH2016_2-8" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Ankylosing spondylitis is believed to involve a combination of genetic and environmental factors.<sup id="cite_ref-NIH2016_2-9" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> More than 90% of people affected in the <a href="/wiki/United_Kingdom" title="United Kingdom">UK</a> have a specific <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">human leukocyte antigen</a> known as the <a href="/wiki/HLA-B27" title="HLA-B27">HLA-B27</a> antigen.<sup id="cite_ref-The_ramifications_of_HLA-B27_7-0" class="reference"><a href="#cite_note-The_ramifications_of_HLA-B27-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The underlying mechanism is believed to be <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune</a> or <a href="/wiki/Autoinflammatory_disease" class="mw-redirect" title="Autoinflammatory disease">autoinflammatory</a>.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Diagnosis is based on symptoms with support from <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a> and <a href="/wiki/Blood_tests" class="mw-redirect" title="Blood tests">blood tests</a>.<sup id="cite_ref-NIH2016_2-10" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> AS is a type of <a href="/wiki/Spondyloarthropathy#Seronegative_spondyloarthropathy" class="mw-redirect" title="Spondyloarthropathy">seronegative spondyloarthropathy</a>, meaning that tests show no presence of <a href="/wiki/Rheumatoid_factor" title="Rheumatoid factor">rheumatoid factor</a> (RF) <a href="/wiki/Antibody" title="Antibody">antibodies</a>.<sup id="cite_ref-NIH2016_2-11" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>There is no cure for AS. Treatments may include medication, physical therapy, and surgery. Medication therapy focuses on relieving the pain and other symptoms of AS, as well as stopping disease progression by counteracting long-term inflammatory processes. Commonly used medications include <a href="/wiki/NSAIDs" class="mw-redirect" title="NSAIDs">NSAIDs</a>, <a href="/wiki/TNF_inhibitor" title="TNF inhibitor">TNF inhibitors</a>, <a href="/wiki/Interleukin-17A" title="Interleukin-17A">IL-17</a> antagonists, and <a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">DMARDs</a>. <a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoid</a> injections are often used for acute and localized flare-ups.<sup id="cite_ref-:0_9-0" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>About 0.1% to 0.8% of the population are affected, with onset typically occurring in young adults.<sup id="cite_ref-NIH2016_2-12" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Kh2009_4-1" class="reference"><a href="#cite_note-Kh2009-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> While men and women are equally affected with AS, women are more likely to experience inflammation rather than fusion.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Blausen_0037_AnkylosingSpondylitis.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Blausen_0037_AnkylosingSpondylitis.png/220px-Blausen_0037_AnkylosingSpondylitis.png" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Blausen_0037_AnkylosingSpondylitis.png/330px-Blausen_0037_AnkylosingSpondylitis.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Blausen_0037_AnkylosingSpondylitis.png/440px-Blausen_0037_AnkylosingSpondylitis.png 2x" data-file-width="768" data-file-height="1024" /></a><figcaption>Illustration depicting ankylosing spondylitis</figcaption></figure> <p>The signs and symptoms of ankylosing spondylitis often appear gradually, with peak onset between 20 and 30 years of age.<sup id="cite_ref-Patient_UK_7_11-0" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Initial symptoms are usually a <a href="/wiki/Chronic_(medicine)" class="mw-redirect" title="Chronic (medicine)">chronic</a> dull pain in the lower back or <a href="/wiki/Gluteal_muscles" title="Gluteal muscles">gluteal</a> region combined with stiffness of the lower back.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Individuals often experience pain and stiffness that awakens them in the early morning hours.<sup id="cite_ref-Patient_UK_7_11-1" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>As the disease progresses, loss of spinal mobility and chest expansion, with a limitation of anterior <a href="/wiki/Anatomical_terms_of_motion" title="Anatomical terms of motion">flexion</a>, lateral flexion, and extension of the lumbar spine are seen. Systemic features are common with weight loss, fever, or fatigue often present.<sup id="cite_ref-Patient_UK_7_11-2" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Pain is often severe at rest but may improve with physical activity. Inflammation and pain may recur to varying degrees regardless of rest and movement. </p><p>AS can occur in any part of the spine or the entire spine, often with pain localized to either buttock or the back of the thigh from the <a href="/wiki/Sacroiliac_joint" title="Sacroiliac joint">sacroiliac joint</a>. Arthritis in the hips and shoulders may also occur. When the condition presents before the age of 18, AS is more likely to cause pain and swelling of large lower limb joints, such as the knees.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-0" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> In prepubescent cases, pain and swelling may also manifest in the ankles and feet where <a href="/wiki/Calcaneal_spur" title="Calcaneal spur">heel</a> pain and <a href="/wiki/Enthesopathy" title="Enthesopathy">enthesopathy</a> commonly develop.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-1" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Less common occurrences include <a href="/wiki/Ectasia" title="Ectasia">ectasia</a> of the sacral nerve root sheaths.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>About 30% of people with AS will also experience anterior <a href="/wiki/Uveitis" title="Uveitis">uveitis</a> causing eye pain, redness, and blurred vision. This is thought to be due to the association that both AS and uveitis have with the presence of the <a href="/wiki/HLA-B27" title="HLA-B27">HLA-B27</a> antigen.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Cardiovascular involvement may include <a href="/wiki/Aortitis" title="Aortitis">inflammation of the aorta</a>, <a href="/wiki/Aortic_valve_insufficiency" class="mw-redirect" title="Aortic valve insufficiency">aortic valve insufficiency</a> or <a href="/wiki/Electrical_conduction_system_of_the_heart" class="mw-redirect" title="Electrical conduction system of the heart">disturbances of the heart's electrical conduction system</a>. Lung involvement is characterized by progressive <a href="/wiki/Lung_fibrosis" class="mw-redirect" title="Lung fibrosis">fibrosis</a> of the <a href="/wiki/Apex_of_lung" class="mw-redirect" title="Apex of lung">upper portion of the lung</a>.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=2" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Ankylosing_process.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Ankylosing_process.jpg/256px-Ankylosing_process.jpg" decoding="async" width="256" height="256" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Ankylosing_process.jpg/384px-Ankylosing_process.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/99/Ankylosing_process.jpg/512px-Ankylosing_process.jpg 2x" data-file-width="1545" data-file-height="1548" /></a><figcaption>The <a href="/wiki/Ankylosis" title="Ankylosis">ankylosis</a> process</figcaption></figure> <p>Ankylosing <a href="/wiki/Spondylitis" title="Spondylitis">spondylitis</a> (AS) is a systemic <a href="/wiki/Rheumatology" title="Rheumatology">rheumatic</a> disease, meaning it affects the entire body. 1–2% of individuals with the <a href="/wiki/HLA-B27" title="HLA-B27">HLA-B27 genotype</a> develop the disease.<sup id="cite_ref-Patient_UK_5_17-0" class="reference"><a href="#cite_note-Patient_UK_5-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Tumor_necrosis_factor-alpha" class="mw-redirect" title="Tumor necrosis factor-alpha">Tumor necrosis factor-alpha</a> (TNF α) and <a href="/wiki/Interleukin-1_family" title="Interleukin-1 family">interleukin 1</a> (IL-1) are also implicated in ankylosing spondylitis. Autoantibodies specific for AS have not been identified. <a href="/wiki/Anti-neutrophil_cytoplasmic_antibody" title="Anti-neutrophil cytoplasmic antibody">Anti-neutrophil cytoplasmic antibodies</a> (ANCAs) are associated with AS, but do not correlate with disease severity.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Single_nucleotide_polymorphism" class="mw-redirect" title="Single nucleotide polymorphism">Single nucleotide polymorphism</a> (SNP) A/G variant rs10440635<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> is close to the <i><a href="/wiki/Prostaglandin_EP4_receptor" title="Prostaglandin EP4 receptor">PTGER4</a></i> gene on human chromosome 5 has been associated with an increased number of cases of AS in a population recruited from the United Kingdom, Australia, and Canada. The <i>PTGER4</i> gene codes for the <a href="/wiki/Prostaglandin_EP4_receptor" title="Prostaglandin EP4 receptor">prostaglandin EP<sub>4</sub> receptor</a>, one of four receptors for <a href="/wiki/Prostaglandin_E2" title="Prostaglandin E2">prostaglandin E<sub>2</sub></a>. Activation of EP<sub>4</sub> promotes bone remodeling and deposition (see <a href="/wiki/Prostaglandin_EP4_receptor#Bone" title="Prostaglandin EP4 receptor">prostaglandin EP4 receptor § Bone</a>) and EP<sub>4</sub> is highly expressed at vertebral column sites involved in AS. These findings suggest that excessive EP<sub>4</sub> activation contributes to pathological bone remodeling and deposition in AS and that the A/G variant rs10440635a of <i>PTGER4</i> predisposes individuals to this disease, possibly by influencing EP4's production or expression pattern.<sup id="cite_ref-pmid21743469_20-0" class="reference"><a href="#cite_note-pmid21743469-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid25935456_21-0" class="reference"><a href="#cite_note-pmid25935456-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>The association of AS with HLA-B27 suggests the condition involves <a href="/wiki/Cytotoxic_T_cell" title="Cytotoxic T cell">CD8 T cells</a>, which interact with <a href="/wiki/HLA-B" title="HLA-B">HLA-B</a>.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> This interaction is not proven to involve a self-antigen, and at least in the related <a href="/wiki/Reactive_arthritis" title="Reactive arthritis">reactive arthritis</a>, which follows infections, the antigens involved are likely to be derived from intracellular microorganisms.<sup id="cite_ref-The_ramifications_of_HLA-B27_7-1" class="reference"><a href="#cite_note-The_ramifications_of_HLA-B27-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> There is, however, a possibility that <a href="/wiki/CD4%2B_T_lymphocytes" class="mw-redirect" title="CD4+ T lymphocytes">CD4+ T lymphocytes</a> are involved in an aberrant way, since HLA-B27 appears to have a number of unusual properties, including possibly an ability to interact with T cell receptors in association with <a href="/wiki/CD4" title="CD4">CD4</a> (usually <a href="/wiki/CD8%2B_cytotoxic_T_cell" class="mw-redirect" title="CD8+ cytotoxic T cell">CD8+ cytotoxic T cell</a> with HLAB antigen as it is a <a href="/wiki/MHC_class_I" title="MHC class I">MHC class 1 antigen</a>). </p><p>"Bamboo spine" develops when the outer fibers of the <a href="/wiki/Anulus_fibrosus_disci_intervertebralis" class="mw-redirect" title="Anulus fibrosus disci intervertebralis">fibrous ring</a> (<i>anulus fibrosus disci intervertebralis</i>) of the <a href="/wiki/Intervertebral_disc" title="Intervertebral disc">intervertebral discs</a> ossify, which results in the formation of marginal <a href="/wiki/Syndesmophyte" title="Syndesmophyte">syndesmophytes</a> between adjoining vertebrae. </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=3" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:12891_2006_Article_297_Fig5_HTML.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e1/12891_2006_Article_297_Fig5_HTML.jpg/220px-12891_2006_Article_297_Fig5_HTML.jpg" decoding="async" width="220" height="195" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e1/12891_2006_Article_297_Fig5_HTML.jpg/330px-12891_2006_Article_297_Fig5_HTML.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e1/12891_2006_Article_297_Fig5_HTML.jpg/440px-12891_2006_Article_297_Fig5_HTML.jpg 2x" data-file-width="1200" data-file-height="1065" /></a><figcaption>34-year-old male with AS. Inflammatory lesions of the anterior chest wall are shown (curved arrows). Inflammatory changes are seen in the lower thoracic spine and L1 (arrows).</figcaption></figure> <p>Ankylosing spondylitis is a member of the more broadly defined disease <a href="/wiki/Axial_spondyloarthritis" title="Axial spondyloarthritis">axial spondyloarthritis</a>.<sup id="cite_ref-Classification2009_23-0" class="reference"><a href="#cite_note-Classification2009-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Axial spondyloarthritis can be divided into two categories: radiographic axial spondyloarthritis (which is a synonym for ankylosing spondylitis) and non-radiographic axial spondyloarthritis (which include less severe forms and early stages of ankylosing spondylitis).<sup id="cite_ref-Classification2009_23-1" class="reference"><a href="#cite_note-Classification2009-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>While AS can be diagnosed through the description of radiological changes in the <a href="/wiki/Sacroiliac_joint" title="Sacroiliac joint">sacroiliac joints</a> and <a href="/wiki/Vertebral_column" title="Vertebral column">spine</a>, there are currently no direct tests (blood or imaging) to unambiguously diagnose early forms of ankylosing spondylitis (<a href="/wiki/Non-radiographic_axial_spondyloarthritis" class="mw-redirect" title="Non-radiographic axial spondyloarthritis">non-radiographic axial spondyloarthritis</a>). Diagnosis of non-radiologic axial spondyloarthritis is therefore more difficult and is based on the presence of several typical disease features.<sup id="cite_ref-Classification2009_23-2" class="reference"><a href="#cite_note-Classification2009-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Poddubnyyvan_Tubergen2015_25-0" class="reference"><a href="#cite_note-Poddubnyyvan_Tubergen2015-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>These diagnostic criteria include: </p> <ul><li>Inflammatory back pain:<br />Chronic, inflammatory back pain is defined when at least four out of five of the following parameters are present: (1) Age of onset below 40 years old, (2) insidious onset, (3) improvement with exercise, (4) no improvement with rest, and (5) pain at night (with improvement upon getting up). Pain often subsides as the day progresses with movement being of importance to alleviate the joint stiffness.</li> <li>Past history of inflammation in the joints, heels, or tendon-bone attachments</li> <li>Family history for axial spondyloarthritis or other associated rheumatic/autoimmune conditions</li> <li>Positive for the <a href="/wiki/Biomarker" title="Biomarker">biomarker</a> <a href="/wiki/HLA-B27" title="HLA-B27">HLA-B27</a></li> <li>Good response to treatment with <a href="/wiki/Nonsteroidal_anti-inflammatory_drugs" class="mw-redirect" title="Nonsteroidal anti-inflammatory drugs">nonsteroidal anti-inflammatory drugs</a> (NSAIDs)</li> <li>Signs of elevated inflammation (<a href="/wiki/C-reactive_protein" title="C-reactive protein">C-reactive protein</a> and <a href="/wiki/Erythrocyte_sedimentation_rate" title="Erythrocyte sedimentation rate">erythrocyte sedimentation rate</a>)</li> <li>Manifestation of <a href="/wiki/Psoriasis" title="Psoriasis">psoriasis</a>, <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a>, or inflammation of the eye (<a href="/wiki/Uveitis" title="Uveitis">uveitis</a>)</li></ul> <p>If these criteria still do not give a compelling diagnosis <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> (MRI) may be useful.<sup id="cite_ref-Classification2009_23-3" class="reference"><a href="#cite_note-Classification2009-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Poddubnyyvan_Tubergen2015_25-1" class="reference"><a href="#cite_note-Poddubnyyvan_Tubergen2015-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> MRI can show <a href="/wiki/Sacroiliitis" title="Sacroiliitis">inflammation of the sacroiliac joint</a>. </p> <div class="mw-heading mw-heading3"><h3 id="Imaging">Imaging</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=4" title="Edit section: Imaging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="X-rays">X-rays</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=5" title="Edit section: X-rays"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The earliest changes demonstrable by plain X-ray shows erosions and sclerosis in sacroiliac joints. Progression of the erosions leads to widening of the joint space and bony sclerosis. X-ray spine can reveal squaring of vertebrae with bony spur formation called <a href="/wiki/Syndesmophyte" title="Syndesmophyte">syndesmophyte</a>. This causes the bamboo spine appearance. A drawback of X-ray diagnosis is the signs and symptoms of AS have usually been established as long as 7–10 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.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>Options for earlier diagnosis are <a href="/wiki/Computed_tomography" class="mw-redirect" title="Computed tomography">tomography</a> and MRI of the sacroiliac joints, but the reliability of these tests is still unclear. </p> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:AnkSponTLateral2016.png" class="mw-file-description" title="Lateral X-ray of the mid back in ankylosing spondylitis"><img alt="Lateral X-ray of the mid back in ankylosing spondylitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/AnkSponTLateral2016.png/92px-AnkSponTLateral2016.png" decoding="async" width="92" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/AnkSponTLateral2016.png/138px-AnkSponTLateral2016.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/91/AnkSponTLateral2016.png/184px-AnkSponTLateral2016.png 2x" data-file-width="1008" data-file-height="1311" /></a></span></div> <div class="gallerytext">Lateral X-ray of the mid back in ankylosing spondylitis</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:AnkSponCLateral2016.png" class="mw-file-description" title="Lateral X-ray of the neck in ankylosing spondylitis"><img alt="Lateral X-ray of the neck in ankylosing spondylitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9e/AnkSponCLateral2016.png/113px-AnkSponCLateral2016.png" decoding="async" width="113" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9e/AnkSponCLateral2016.png/170px-AnkSponCLateral2016.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9e/AnkSponCLateral2016.png/227px-AnkSponCLateral2016.png 2x" data-file-width="994" data-file-height="1052" /></a></span></div> <div class="gallerytext">Lateral X-ray of the neck in ankylosing spondylitis</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:Bamboo_spine_ankylosing_spondylitis.jpg" class="mw-file-description" title="X-ray showing bamboo spine in a person with ankylosing spondylitis"><img alt="X-ray showing bamboo spine in a person with ankylosing spondylitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b0/Bamboo_spine_ankylosing_spondylitis.jpg/76px-Bamboo_spine_ankylosing_spondylitis.jpg" decoding="async" width="76" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b0/Bamboo_spine_ankylosing_spondylitis.jpg/114px-Bamboo_spine_ankylosing_spondylitis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b0/Bamboo_spine_ankylosing_spondylitis.jpg/152px-Bamboo_spine_ankylosing_spondylitis.jpg 2x" data-file-width="452" data-file-height="712" /></a></span></div> <div class="gallerytext">X-ray showing bamboo spine in a person with ankylosing spondylitis</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:Ankylosing_spondylitis.jpg" class="mw-file-description" title="CT scan showing bamboo spine in ankylosing spondylitis"><img alt="CT scan showing bamboo spine in ankylosing spondylitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Ankylosing_spondylitis.jpg/120px-Ankylosing_spondylitis.jpg" decoding="async" width="120" height="109" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Ankylosing_spondylitis.jpg/180px-Ankylosing_spondylitis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Ankylosing_spondylitis.jpg/240px-Ankylosing_spondylitis.jpg 2x" data-file-width="405" data-file-height="369" /></a></span></div> <div class="gallerytext">CT scan showing bamboo spine in ankylosing spondylitis</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><span typeof="mw:File"><a href="/wiki/File:M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg" class="mw-file-description" title="T1-weighted MRI with fat suppression after administration of gadolinium contrast showing sacroiliitis in a person with ankylosing spondylitis"><img alt="T1-weighted MRI with fat suppression after administration of gadolinium contrast showing sacroiliitis in a person with ankylosing spondylitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/22/M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg/120px-M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg" decoding="async" width="120" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/22/M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg/180px-M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/22/M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg/240px-M_Bechterew2_Spond_li_ISG_MR_pcor_T1_FatSAT_mit_GD.jpg 2x" data-file-width="512" data-file-height="512" /></a></span></div> <div class="gallerytext">T1-weighted MRI with fat suppression after administration of <a href="/wiki/MRI_contrast_agent#Gadolinium(III)" title="MRI contrast agent">gadolinium</a> contrast showing sacroiliitis in a person with ankylosing spondylitis</div> </li> </ul> <div class="mw-heading mw-heading3"><h3 id="Blood_parameters">Blood parameters</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=6" title="Edit section: Blood parameters"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>During acute inflammatory periods, people with AS may show an increase in the blood concentration of CRP and an increase in the ESR, but there are many with AS whose CRP and ESR rates do not increase, so normal CRP and ESR results do not always correspond with the amount of inflammation that is actually present. In other words, some people with AS have normal levels of CRP and ESR, despite experiencing a significant amount of inflammation in their bodies.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Genetic_testing">Genetic testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=7" title="Edit section: Genetic testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>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 <a href="/wiki/Blood_test" title="Blood test">blood test</a>, can occasionally help with diagnosis, but in itself is not diagnostic of AS in a person with back pain. Over 85% of people that have been diagnosed with AS are HLA-B27 positive, although this ratio varies from population to population (about 50% of African Americans with AS possess HLA-B27 in contrast to the figure of 80% among those with AS who are of Mediterranean descent).<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="BASDAI">BASDAI</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=8" title="Edit section: BASDAI"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Bath Ankylosing Spondylitis Disease Activity Index (<a href="/wiki/BASDAI" title="BASDAI">BASDAI</a>), developed in <a href="/wiki/Bath,_Somerset" title="Bath, Somerset">Bath</a> (UK), is an index designed to detect the inflammatory burden of active disease. The BASDAI 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.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> It can be easily calculated and accurately assesses the need for additional therapy; a person with AS with a score of four out of a possible 10 points while on adequate NSAID therapy is usually considered a good candidate for biologic therapy. </p><p>The Bath Ankylosing Spondylitis Functional Index (BASFI) is a functional index which can accurately assess functional impairment due to the disease, as well as improvements following therapy.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> The BASFI is not usually used as a diagnostic tool, but rather as a tool to establish a current baseline and subsequent response to therapy. </p> <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=9" title="Edit section: Children"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Juvenile ankylosing spondylitis (JAS) is a rare form of the disease which differs from the more common adult form.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-2" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Enthesopathy" title="Enthesopathy">Enthesophathy</a> and arthritis of large joints of the lower extremities is more common than the characteristic early-morning back pain seen in adult AS.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-3" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Ankylosing tarsitis of the <a href="/wiki/Ankle" title="Ankle">ankle</a> is a common feature, as is the more classical findings of seronegative <a href="/wiki/Anti-nuclear_antibody" class="mw-redirect" title="Anti-nuclear antibody">ANA</a> and <a href="/wiki/Rheumatoid_factor" title="Rheumatoid factor">RF</a> as well as presence of the HLA-B27 allele.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-4" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Primary engagement of the appendicular joints may explain delayed diagnosis; however, other common symptoms of AS such as <a href="/wiki/Uveitis" title="Uveitis">uveitis</a>, diarrhea, pulmonary disease and heart valve disease may lead suspicion away from other <a href="/w/index.php?title=Juvenile_spondyloarthropathy&action=edit&redlink=1" class="new" title="Juvenile spondyloarthropathy (page does not exist)">juvenile spondyloarthropathies</a>.<sup id="cite_ref-Adrovic,_Barut,_Sahin,_Kasapcopur_13-5" class="reference"><a href="#cite_note-Adrovic,_Barut,_Sahin,_Kasapcopur-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Schober's_test"><span id="Schober.27s_test"></span>Schober's test</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=10" title="Edit section: Schober's test"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Schober%27s_test" title="Schober's test">Schober's test</a> is a useful clinical measure of flexion of the lumbar spine performed during the physical examination.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=11" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is no cure for AS,<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> but treatments and medications can reduce symptoms and pain. </p> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=12" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Medications for AS may be broadly considered either "disease-modifying" or "non-disease-modifying". Disease-modifying medications for ankylosing spondylitis aim to slow disease progression and include drugs like tumor necrosis factor (TNF) inhibitors. Non-disease-modifying medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), primarily address symptoms like pain and inflammation but do not alter the course of the disease.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="NSAIDs">NSAIDs</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=13" title="Edit section: NSAIDs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Unless otherwise contraindicated, all people with AS are recommended to take <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">non-steroidal anti-inflammatory drugs</a> (NSAIDs). The dose, frequency, and specific drug may depend on the individual and the symptoms they experience. NSAIDs, such as ibuprofen and naproxen, are used to alleviate pain, reduce inflammation, and improve joint stiffness associated with AS. These medications work by inhibiting the activity of <a href="/wiki/Cyclooxygenase" title="Cyclooxygenase">cyclooxygenase</a> (COX) enzymes, which are involved in the production of inflammatory <a href="/wiki/Prostaglandin" title="Prostaglandin">prostaglandins</a>. By reducing the levels of prostaglandins, NSAIDs help mitigate the <a href="/wiki/Inflammation" title="Inflammation">inflammatory response</a> and relieve symptoms in individuals with ankylosing spondylitis.<sup id="cite_ref-:0_9-1" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="TNF_inhibitors">TNF inhibitors</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=14" title="Edit section: TNF inhibitors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tumor necrosis factor inhibitors (TNFi) are a class of biologic drugs used in the treatment of ankylosing spondylitis. TNFi drugs, such as <a href="/wiki/Etanercept" title="Etanercept">etanercept</a>, <a href="/wiki/Infliximab" title="Infliximab">infliximab</a>, <a href="/wiki/Adalimumab" title="Adalimumab">adalimumab</a>, <a href="/wiki/Certolizumab_pegol" title="Certolizumab pegol">certolizumab</a>, and <a href="/wiki/Golimumab" title="Golimumab">golimumab</a>, target the inflammatory cytokine <a href="/wiki/Tumor_necrosis_factor-alpha" class="mw-redirect" title="Tumor necrosis factor-alpha">tumor necrosis factor-alpha</a> (TNF-alpha). TNF-alpha plays a key role in the inflammatory process in ankylosing spondylitis. By blocking TNF-alpha, TNFi drugs help reduce inflammation, pain, and stiffness associated with AS, and may also slow down the progression of spinal damage.<sup id="cite_ref-:0_9-2" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Non-TNFi_biologics">Non-TNFi biologics</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=15" title="Edit section: Non-TNFi biologics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Non-TNFi "biologic" drugs used in the treatment of ankylosing spondylitis include drugs that target different pathways involved in the inflammatory process. Two of the most important drugs in this class target <a href="/wiki/Interleukin-17A" title="Interleukin-17A">IL-17</a>, an important part of the inflammatory system: <a href="/wiki/Secukinumab" title="Secukinumab">secukinumab</a> and <a href="/wiki/Ixekizumab" title="Ixekizumab">ixekizumab</a>. They are often considered in cases where TNFi drugs are not effective or cause too many side effects. Additionally, they may sometimes be used as an <a href="/wiki/Adjuvant_therapy" title="Adjuvant therapy">adjunct</a> to a TNFi when symptoms persist, but improve, while the patient is on the TNFi. The choice of a specific non-TNFi biologic depends on various factors, including the patient's medical history, preferences, and the recommendations of the healthcare provider.<sup id="cite_ref-:0_9-3" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Ustekinumab" title="Ustekinumab">Ustekinumab</a> has frequently been used as a <a href="/wiki/Second-line_medication" class="mw-redirect" title="Second-line medication">second-line therapy</a> for AS, but it has recently been scrutinized for a lack of efficacy, and is no longer recommended.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_9-4" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Biosimilar_drugs">Biosimilar drugs</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=16" title="Edit section: Biosimilar drugs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Biosimilar" title="Biosimilar">Biosimilar</a> drugs are biological products that are highly similar to an already approved biologic drug, with few or no clinically meaningful differences in terms of safety, purity, and potency. These drugs are developed to be equivalent to the reference biologic, often at a lower cost, providing alternative treatment options. In the context of ankylosing spondylitis, biosimilars are typically used as alternatives to the original biologic drugs. Biosimilars for ankylosing spondylitis may include versions of tumor necrosis factor inhibitors or other biologics commonly used in the treatment of the condition. When possible, physicians are recommended to use the original drugs over the biosimilar versions. Even biosimilars with perfect replication of the quality, composition, and other properties of the original drug are susceptible to <a href="/wiki/Nocebo" title="Nocebo">nocebo</a> effects.<sup id="cite_ref-:0_9-5" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="csARDs">csARDs</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=17" title="Edit section: csARDs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/w/index.php?title=Conventional_synthetic_antirheumatic_drugs&action=edit&redlink=1" class="new" title="Conventional synthetic antirheumatic drugs (page does not exist)">Conventional synthetic antirheumatic drugs</a> (csARDs) are a class of disease-modifying medications. Unlike biologics or targeted synthetic drugs, which act on specific pathways in the immune system, csARDs have a broader effect on the immune system and are often considered traditional or conventional treatments. The most common drugs in this class are <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a> and <a href="/wiki/Sulfasalazine" title="Sulfasalazine">sulfasalazine</a>. These medications are only used when others fail, or when certain specific conditions are met, and are often discontinued if a patient's symptoms become manageable with just a TNFi or other medication. Conventional <a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">DMARDs</a> such as <a href="/wiki/Leflunomide" title="Leflunomide">leflunomide</a> are also considered to be part of this class.<sup id="cite_ref-:0_9-6" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Concerns exist about a possible lack of <a href="/wiki/Efficacy" title="Efficacy">efficacy</a> of some drugs in this class.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Corticosteroids">Corticosteroids</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=18" title="Edit section: Corticosteroids"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a>, such as <a href="/wiki/Prednisone" title="Prednisone">prednisone</a> or <a href="/wiki/Methylprednisolone" title="Methylprednisolone">methylprednisolone</a>, are sometimes used in the treatment of ankylosing spondylitis to manage acute flares and provide short-term relief from inflammation and symptoms. They are powerful anti-inflammatory medications that can help reduce pain, swelling, and stiffness associated with AS. However, glucocorticoids are generally not recommended for long-term use. They are more commonly used as localized <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">injections</a> when someone with AS has a temporary pain flare in a particular joint or area.<sup id="cite_ref-:0_9-7" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=19" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>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 very risky. In addition, AS can have some manifestations that make anesthesia more complex. Changes in the upper airway can lead to difficulties in intubating the airway, spinal and epidural anesthesia may be difficult owing to calcification of ligaments, and a small number of people have <a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">aortic insufficiency</a>. The stiffness of the thoracic ribs results in ventilation being mainly diaphragm-driven, so there may also be a decrease in pulmonary function. </p> <div class="mw-heading mw-heading3"><h3 id="Physical_therapy">Physical therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=20" title="Edit section: Physical therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Though physical therapy remedies have been scarcely documented, some therapeutic exercises are used to help manage lower back, neck, knee, and shoulder pain. There is moderate quality evidence that therapeutic exercise programs help reduce pain and improve function.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Therapeutic exercises include:<sup id="cite_ref-Philadelphia_Panel_2001_40-0" class="reference"><a href="#cite_note-Philadelphia_Panel_2001-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Exercise programs, either at home or supervised</li> <li>Low intensity aerobic exercise, e.g. <a href="/wiki/Pilates" title="Pilates">Pilates</a></li> <li><a href="/wiki/Aquatic_therapy" title="Aquatic therapy">Spa-exercise therapy</a></li> <li>Aquatic physical therapy<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Proprioceptive_neuromuscular_facilitation" class="mw-redirect" title="Proprioceptive neuromuscular facilitation">Proprioceptive neuromuscular facilitation</a> (PNF)</li> <li><a href="/wiki/Heat_therapy" title="Heat therapy">Heat therapy</a></li> <li>Cryotherapy in conjunction with exercise<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Diet">Diet</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=21" title="Edit section: Diet"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Research by Alan Ebringer at King's College in London, beginning in the 1980s, implicates overgrowth of the bacterium <i>Klebsiella pneumoniae</i> in the symptoms of ankylosing spondylitis. The body produces antibodies that attack <i>Klebsiella pneumoniae</i>. Enzymes made by the bacterium resemble human proteins, including three types of collagen (I, III, IV) and the HLA-B27 complex of glycoproteins. The antibodies therefore attack these human proteins, producing the symptoms of ankylosing spondylitis. Ebringer and others recommend low-starch or no-starch diets.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=22" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:TwospinalfracturesAnkSpondT5C7.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/TwospinalfracturesAnkSpondT5C7.png/220px-TwospinalfracturesAnkSpondT5C7.png" decoding="async" width="220" height="235" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/TwospinalfracturesAnkSpondT5C7.png/330px-TwospinalfracturesAnkSpondT5C7.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/TwospinalfracturesAnkSpondT5C7.png/440px-TwospinalfracturesAnkSpondT5C7.png 2x" data-file-width="896" data-file-height="957" /></a><figcaption>Fracture of the T5 and C7 vertebra due to trauma in a person with ankylosing spondylitis as seen on a CT scan</figcaption></figure> <p>Prognosis is related to disease severity.<sup id="cite_ref-Patient_UK_7_11-3" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> AS can range from mild to progressively debilitating and from medically controlled to refractory. Some cases may have times of active inflammation followed by times of remission resulting in minimal disability while others never have times of remission and have acute inflammation and pain, leading to significant disability.<sup id="cite_ref-Patient_UK_7_11-4" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> As the disease progresses, it can cause the vertebrae and the lumbosacral joint to ossify, resulting in the fusion of the spine.<sup id="cite_ref-pmid12381506_45-0" class="reference"><a href="#cite_note-pmid12381506-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> This places the spine in a vulnerable state because it becomes one bone, which causes it to lose its range of motion as well as putting it at risk for spinal fractures. This not only limits mobility but reduces the affected person's quality of life. Complete fusion of the spine can lead to a reduced range of motion and increased pain, as well as total joint destruction which could lead to a joint replacement.<sup id="cite_ref-pmid24345154_46-0" class="reference"><a href="#cite_note-pmid24345154-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Osteoporosis" title="Osteoporosis">Osteoporosis</a> is common in ankylosing spondylitis, both from chronic systemic inflammation and decreased mobility resulting from AS. Over a long-term period, <a href="/wiki/Osteopenia" title="Osteopenia">osteopenia</a> or osteoporosis of the AP spine may occur, causing eventual compression fractures and a back "hump".<sup id="cite_ref-pmid26509065_47-0" class="reference"><a href="#cite_note-pmid26509065-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Hyperkyphosis from ankylosing spondylitis can also lead to impairment in mobility and balance, as well as impaired peripheral vision, which increases the risk of falls which can cause fracture of already-fragile vertebrae.<sup id="cite_ref-pmid26509065_47-1" class="reference"><a href="#cite_note-pmid26509065-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Typical signs of progressed AS are the visible formation of <a href="/wiki/Syndesmophyte" title="Syndesmophyte">syndesmophytes</a> on X-rays and abnormal bone outgrowths similar to <a href="/wiki/Osteophyte" title="Osteophyte">osteophytes</a> affecting the spine. In compression fractures of the vertebrae, <a href="/wiki/Paresthesia" title="Paresthesia">paresthesia</a> is a complication due to the inflammation of the tissue surrounding nerves. </p><p>Organs commonly affected by AS, other than the axial <a href="/wiki/Vertebral_column" title="Vertebral column">spine</a> and other joints, are the <a href="/wiki/Heart" title="Heart">heart</a>, <a href="/wiki/Lung" title="Lung">lungs</a>, <a href="/wiki/Human_eye" title="Human eye">eyes</a>, <a href="/wiki/Colon_(anatomy)" class="mw-redirect" title="Colon (anatomy)">colon</a>, and <a href="/wiki/Kidney" title="Kidney">kidneys</a>. Other complications are aortic <a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">regurgitation</a>, <a href="/wiki/Achilles_tendinitis" title="Achilles tendinitis">Achilles tendinitis</a>, <a href="/wiki/Heart_block" title="Heart block">AV node block</a>, and <a href="/wiki/Amyloidosis" title="Amyloidosis">amyloidosis</a>.<sup id="cite_ref-Alpert_48-0" class="reference"><a href="#cite_note-Alpert-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Owing to lung fibrosis, <a href="/wiki/Chest_radiograph" title="Chest radiograph">chest X-rays</a> may show apical fibrosis, while <a href="/wiki/Pulmonary_function_testing" title="Pulmonary function testing">pulmonary function testing</a> may reveal a restrictive lung defect. Very rare complications involve <a href="/wiki/Neurology" title="Neurology">neurologic</a> conditions such as the <a href="/wiki/Cauda_equina_syndrome" title="Cauda equina syndrome">cauda equina syndrome</a>.<sup id="cite_ref-Alpert_48-1" class="reference"><a href="#cite_note-Alpert-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mortality">Mortality</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=23" title="Edit section: Mortality"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Mortality is increased in people with AS and circulatory disease is the most frequent cause of death.<sup id="cite_ref-pmid21784726_50-0" class="reference"><a href="#cite_note-pmid21784726-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> People with AS have an increased risk of 60% for cerebrovascular mortality, and an overall increased risk of 50% for vascular mortality.<sup id="cite_ref-Medscape_51-0" class="reference"><a href="#cite_note-Medscape-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> About one third of those with ankylosing spondylitis have severe disease, which reduces life expectancy.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p><p>As increased mortality in ankylosing spondylitis is related to disease severity, factors negatively affecting outcomes include:<sup id="cite_ref-pmid21784726_50-1" class="reference"><a href="#cite_note-pmid21784726-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid887115_53-0" class="reference"><a href="#cite_note-pmid887115-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Male sex<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup></li> <li>Plus three of the following in the first two years of disease: <ul><li><a href="/wiki/Erythrocyte_sedimentation_rate" title="Erythrocyte sedimentation rate">Erythrocyte sedimentation rate</a> (ESR) >30 mm/h</li> <li>Unresponsive to NSAIDs</li> <li>Limitation of lumbar spine range of motion</li> <li><a href="/wiki/Dactylitis" title="Dactylitis">Sausage-like fingers or toes</a></li> <li><a href="/wiki/Oligoarthritis" title="Oligoarthritis">Oligoarthritis</a></li> <li>Onset <16 years old</li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Gait">Gait</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=24" title="Edit section: Gait"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The hunched position that often results from complete spinal fusion can have an effect on a person's <a href="/wiki/Gait" title="Gait">gait</a>. Increased spinal <a href="/wiki/Kyphosis" title="Kyphosis">kyphosis</a> will lead to a forward and downward shift in <a href="/wiki/Center_of_mass" title="Center of mass">center of mass</a> (COM). This shift in COM has been shown to be compensated by increased knee flexion and ankle <a href="/wiki/Dorsiflexion" class="mw-redirect" title="Dorsiflexion">dorsiflexion</a>. The gait of someone with ankylosing spondylitis often has a cautious pattern because they have decreased ability to absorb shock, and they cannot see the horizon.<sup id="cite_ref-pmid21229328_55-0" class="reference"><a href="#cite_note-pmid21229328-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=25" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Between 0.1% and 0.8% of people are affected.<sup id="cite_ref-Kh2009_4-2" class="reference"><a href="#cite_note-Kh2009-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> The disease is most common in Northern European countries, and seen least in people of Afro-Caribbean descent.<sup id="cite_ref-Patient_UK_7_11-5" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Although the ratio of male to female disease is reportedly 3:1,<sup id="cite_ref-Patient_UK_7_11-6" class="reference"><a href="#cite_note-Patient_UK_7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> many <a href="/wiki/Rheumatologist" class="mw-redirect" title="Rheumatologist">rheumatologists</a> believe the number of women with AS is underdiagnosed, as most women tend to experience milder cases of the disease. The majority of people with AS, including 95 per cent of people of European descent with the disease, express the <a href="/wiki/HLA-B27" title="HLA-B27">HLA-B27</a> antigen<sup id="cite_ref-Cecil_56-0" class="reference"><a href="#cite_note-Cecil-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> and high levels of <a href="/wiki/Immunoglobulin_A" title="Immunoglobulin A">immunoglobulin A</a> (IgA) in the blood.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> In 2007, a team of researchers discovered two genes that may contribute to the cause of AS: <a href="/wiki/ARTS-1" class="mw-redirect" title="ARTS-1">ARTS-1</a> and <a href="/wiki/Interleukin_23" title="Interleukin 23">IL23R</a>.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> Together with HLA-B27, these two genes account for roughly 70 percent of the overall number of cases of the disease. </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=26" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/List_of_people_with_ankylosing_spondylitis" title="List of people with ankylosing spondylitis">List of people with ankylosing spondylitis</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:AS_trask_closeup.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/e/e1/AS_trask_closeup.png" decoding="async" width="207" height="312" class="mw-file-element" data-file-width="207" data-file-height="312" /></a><figcaption>Drawing from 1857 of <a href="/wiki/Leonard_Trask" title="Leonard Trask">Leonard Trask</a> who had a severe case of AS</figcaption></figure> <p>Ankylosing spondylitis was distinguished from <a href="/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">rheumatoid arthritis</a> by <a href="/wiki/Galen" title="Galen">Galen</a> as early as the 2nd century AD.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> Skeletal evidence of the disease (ossification of joints and entheses primarily of the axial skeleton, known as "bamboo spine") was thought to be found in the skeletal remains of a 5000-year-old Egyptian mummy with evidence of bamboo spine.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> However, a subsequent report found that this was not the case.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p><p>The anatomist and surgeon <a href="/wiki/Realdo_Colombo" title="Realdo Colombo">Realdo Colombo</a> described what could have been the disease in 1559,<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> and the first account of pathologic changes to a skeleton possibly associated with AS was published in 1691 by <a href="/wiki/Bernard_Connor" title="Bernard Connor">Bernard Connor</a>.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> In 1818, <a href="/wiki/Sir_Benjamin_Collins_Brodie,_1st_Baronet" title="Sir Benjamin Collins Brodie, 1st Baronet">Benjamin Brodie</a> became the first physician to document a person believed to have active AS who also had accompanying <a href="/wiki/Iritis" class="mw-redirect" title="Iritis">iritis</a>.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p><p>In 1858, David Tucker published a small booklet which clearly described the case of <a href="/wiki/Leonard_Trask" title="Leonard Trask">Leonard Trask</a>, who had severe spinal deformity subsequent to AS.<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> In 1833, Trask fell from a horse, exacerbating the condition and resulting in severe deformity. Tucker reported: </p> <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote"><p>It was not until he [Trask] had exercised for some time that he could perform any labor ... [H]is neck and back have continued to curve drawing his head downward on his breast.</p></blockquote> <p>The account of Trask became the first documented case of AS in the United States, owing to its indisputable description of inflammatory disease characteristics of AS and the hallmark of deforming injury in AS. </p><p>In the late nineteenth century, the <a href="/wiki/Neurophysiologist" class="mw-redirect" title="Neurophysiologist">neurophysiologist</a> <a href="/wiki/Vladimir_Bekhterev" title="Vladimir Bekhterev">Vladimir Bekhterev</a> of Russia in 1893,<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Adolf_Str%C3%BCmpell" title="Adolf Strümpell">Adolf Strümpell</a> of Germany in 1897,<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Pierre_Marie" title="Pierre Marie">Pierre Marie</a> of France in 1898<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> 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 Bekhterev disease, Bechterew's disease or Marie–Strümpell disease. </p><p>The word is from <a href="/wiki/Greek_language" title="Greek language">Greek</a> <i>ankylos</i> meaning crooked, curved or rounded, <i>spondylos</i> meaning vertebra, and <i>-itis</i> meaning inflammation.<sup id="cite_ref-NIH2016_2-13" class="reference"><a href="#cite_note-NIH2016-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=27" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Fibrodysplasia_ossificans_progressiva" title="Fibrodysplasia ossificans progressiva">Fibrodysplasia ossificans progressiva</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=28" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output 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CT and archaeology studies". <i>Arthritis & Rheumatology</i>. <b>66</b> (12): 3311–6. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fart.38864">10.1002/art.38864</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25329920">25329920</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:42296180">42296180</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arthritis+%26+Rheumatology&rft.atitle=Ankylosing+spondylitis+or+diffuse+idiopathic+skeletal+hyperostosis+in+royal+Egyptian+mummies+of+18th+%E2%88%9220th+Dynasties%3F+CT+and+archaeology+studies&rft.volume=66&rft.issue=12&rft.pages=3311-6&rft.date=2014-12&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A42296180%23id-name%3DS2CID&rft_id=info%3Apmid%2F25329920&rft_id=info%3Adoi%2F10.1002%2Fart.38864&rft.aulast=Saleem&rft.aufirst=SN&rft.au=Hawass%2C+Z&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-63"><span class="mw-cite-backlink"><b><a href="#cite_ref-63">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBenoist1995" class="citation journal cs1">Benoist M (April 1995). "Pierre Marie. Pioneer investigator in ankylosing spondylitis". <i>Spine</i>. <b>20</b> (7): 849–52. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00007632-199504000-00022">10.1097/00007632-199504000-00022</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7701402">7701402</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Spine&rft.atitle=Pierre+Marie.+Pioneer+investigator+in+ankylosing+spondylitis&rft.volume=20&rft.issue=7&rft.pages=849-52&rft.date=1995-04&rft_id=info%3Adoi%2F10.1097%2F00007632-199504000-00022&rft_id=info%3Apmid%2F7701402&rft.aulast=Benoist&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-64"><span class="mw-cite-backlink"><b><a href="#cite_ref-64">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBlumberg1958" class="citation journal cs1">Blumberg BS (December 1958). <a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fart.1780010609">"Bernard Connor's description of the pathology of ankylosing spondylitis"</a>. <i>Arthritis and Rheumatism</i>. <b>1</b> (6): 553–63. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fart.1780010609">10.1002/art.1780010609</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/13607268">13607268</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arthritis+and+Rheumatism&rft.atitle=Bernard+Connor%27s+description+of+the+pathology+of+ankylosing+spondylitis&rft.volume=1&rft.issue=6&rft.pages=553-63&rft.date=1958-12&rft_id=info%3Adoi%2F10.1002%2Fart.1780010609&rft_id=info%3Apmid%2F13607268&rft.aulast=Blumberg&rft.aufirst=BS&rft_id=https%3A%2F%2Fdoi.org%2F10.1002%252Fart.1780010609&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-65"><span class="mw-cite-backlink"><b><a href="#cite_ref-65">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLeden1994" class="citation journal cs1">Leden I (1994). "Did Bechterew describe the disease which is named after him? A question raised due to the centennial of his primary report". <i>Scandinavian Journal of Rheumatology</i>. <b>23</b> (1): 42–5. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3109%2F03009749409102134">10.3109/03009749409102134</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8108667">8108667</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Rheumatology&rft.atitle=Did+Bechterew+describe+the+disease+which+is+named+after+him%3F+A+question+raised+due+to+the+centennial+of+his+primary+report&rft.volume=23&rft.issue=1&rft.pages=42-5&rft.date=1994&rft_id=info%3Adoi%2F10.3109%2F03009749409102134&rft_id=info%3Apmid%2F8108667&rft.aulast=Leden&rft.aufirst=I&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-66"><span class="mw-cite-backlink"><b><a href="#cite_ref-66">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.HLAB27.com.com/members/life%20and%20sufferings%20of%20leonard%20trask.pdf">"Life and sufferings of Leonard Trask"</a> <span class="cs1-format">(PDF)</span>. Ankylosing Spondylitis Information Matrix. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20110708180013/http://www.hlab27.com.com/members/life%20and%20sufferings%20of%20leonard%20trask.pdf">Archived</a> <span class="cs1-format">(PDF)</span> from the original on 8 July 2011.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Life+and+sufferings+of+Leonard+Trask&rft.pub=Ankylosing+Spondylitis+Information+Matrix.&rft_id=http%3A%2F%2Fwww.HLAB27.com.com%2Fmembers%2Flife%2520and%2520sufferings%2520of%2520leonard%2520trask.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-67"><span class="mw-cite-backlink"><b><a href="#cite_ref-67">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBechterew1893" class="citation journal cs1">Bechterew W (1893). "Steifigkeit der Wirbelsaule und ihre Verkrummung als besondere Erkrankungsform". <i>Neurol Centralbl</i>. <b>12</b>: 426–434.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurol+Centralbl&rft.atitle=Steifigkeit+der+Wirbelsaule+und+ihre+Verkrummung+als+besondere+Erkrankungsform&rft.volume=12&rft.pages=426-434&rft.date=1893&rft.aulast=Bechterew&rft.aufirst=W&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-68"><span class="mw-cite-backlink"><b><a href="#cite_ref-68">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStrumpell1897" class="citation journal cs1">Strumpell A (1897). <a rel="nofollow" class="external text" href="https://zenodo.org/record/1615818">"Bemerkung uber die chronische ankylosirende Entzundung der Wirbelsaule und der Huftgelenke"</a>. <i>Dtsch Z Nervenheilkd</i>. <b>11</b> (3–4): 338–342. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2FBF01674127">10.1007/BF01674127</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:34700673">34700673</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dtsch+Z+Nervenheilkd&rft.atitle=Bemerkung+uber+die+chronische+ankylosirende+Entzundung+der+Wirbelsaule+und+der+Huftgelenke&rft.volume=11&rft.issue=3%E2%80%934&rft.pages=338-342&rft.date=1897&rft_id=info%3Adoi%2F10.1007%2FBF01674127&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A34700673%23id-name%3DS2CID&rft.aulast=Strumpell&rft.aufirst=A&rft_id=https%3A%2F%2Fzenodo.org%2Frecord%2F1615818&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> <li id="cite_note-69"><span class="mw-cite-backlink"><b><a href="#cite_ref-69">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMarie1898" class="citation journal cs1">Marie P (1898). "Sur la spondylose rhizomelique". <i>Rev Med</i>. <b>18</b>: 285–315.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Rev+Med&rft.atitle=Sur+la+spondylose+rhizomelique&rft.volume=18&rft.pages=285-315&rft.date=1898&rft.aulast=Marie&rft.aufirst=P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkylosing+spondylitis" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ankylosing_spondylitis&action=edit&section=29" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://www.niams.nih.gov/health-topics/ankylosing-spondylitis">Questions and Answers about Ankylosing Spondylitis</a> - US National Institute of Arthritis and Musculoskeletal and Skin Diseases</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output .navbox-list{line-height:1.5em;border-color:#fdfdfd}.mw-parser-output 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q52849" class="extiw" title="d:Q52849">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1505896560%2Funspecified">FA92.0Z</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/M08.1">M08.1</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/M45">M45</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=720">720</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/106300">106300</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D013167">D013167</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb728.htm">728</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/9631008">9631008</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000420.htm">000420</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/radio/41-overview">radio/41</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/ankylosing-spondylitis">Ankylosing spondylitis</a></li><li><b><a href="/wiki/Radiopaedia" title="Radiopaedia">Radiopaedia</a></b>: <a rel="nofollow" class="external text" href="https://radiopaedia.org/articles/904">904</a></li><li><b>Scholia</b>: <a class="external text" href="https://tools.wmflabs.org/scholia/topic/Q52849">Q52849</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_joints" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Arthropathies_and_related_conditions" title="Template:Arthropathies and related conditions"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Arthropathies_and_related_conditions" title="Template talk:Arthropathies and related conditions"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Arthropathies_and_related_conditions" title="Special:EditPage/Template:Arthropathies and related conditions"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_joints" style="font-size:114%;margin:0 4em"><a href="/wiki/Arthropathy" title="Arthropathy">Diseases of joints</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthritis" title="Arthritis">Arthritis</a></li> <li><a href="/wiki/Monoarthritis" title="Monoarthritis">Monoarthritis</a></li> <li><a href="/wiki/Oligoarthritis" title="Oligoarthritis">Oligoarthritis</a></li> <li><a href="/wiki/Polyarthritis" title="Polyarthritis">Polyarthritis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Symptoms</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthralgia" title="Arthralgia">Joint pain</a></li> <li><a href="/wiki/Joint_stiffness" title="Joint stiffness">Joint stiffness</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammatory</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Septic_arthritis" title="Septic arthritis">Infectious</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Septic_arthritis" title="Septic arthritis">Septic arthritis</a></li> <li><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis arthritis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Crystal_arthropathy" title="Crystal arthropathy">Crystal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chondrocalcinosis" title="Chondrocalcinosis">Chondrocalcinosis</a></li> <li><a href="/wiki/Calcium_pyrophosphate_dihydrate_crystal_deposition_disease" title="Calcium pyrophosphate dihydrate crystal deposition disease">CPPD</a> (Pseudogout)</li> <li><a href="/wiki/Gout" title="Gout">Gout</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Seronegative_spondyloarthropathy" class="mw-redirect" title="Seronegative spondyloarthropathy">Seronegative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Reactive_arthritis" title="Reactive arthritis">Reactive arthritis</a></li> <li><a href="/wiki/Psoriatic_arthritis" title="Psoriatic arthritis">Psoriatic arthritis</a></li> <li><a class="mw-selflink selflink">Ankylosing spondylitis</a></li> <li><a href="/wiki/Enteropathic_arthropathy" title="Enteropathic arthropathy">Enteropathic arthropathy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Connective_tissue_disorders" class="mw-redirect" title="Connective tissue disorders">Connective tissue disorders</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/SLE" class="mw-redirect" title="SLE">SLE</a></li> <li><a href="/wiki/Systemic_sclerosis" class="mw-redirect" title="Systemic sclerosis">systemic sclerosis</a></li> <li><a href="/wiki/Sj%C3%B6gren%27s" class="mw-redirect" title="Sjögren's">Sjögren's</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Juvenile_idiopathic_arthritis" title="Juvenile idiopathic arthritis">Juvenile idiopathic arthritis</a> <ul><li><a href="/wiki/Systemic-onset_juvenile_idiopathic_arthritis" title="Systemic-onset juvenile idiopathic arthritis">Systemic-onset juvenile idiopathic arthritis</a></li></ul></li> <li><a href="/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">Rheumatoid arthritis</a> <ul><li><a href="/wiki/Felty%27s_syndrome" title="Felty's syndrome">Felty's syndrome</a></li></ul></li> <li><a href="/wiki/Palindromic_rheumatism" title="Palindromic rheumatism">Palindromic rheumatism</a></li> <li><a href="/wiki/Adult-onset_Still%27s_disease" title="Adult-onset Still's disease">Adult-onset Still's disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Noninflammatory</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hemarthrosis" title="Hemarthrosis">Hemarthrosis</a></li> <li><a href="/wiki/Osteoarthritis" title="Osteoarthritis">Osteoarthritis</a> <ul><li><a href="/wiki/Heberden%27s_node" title="Heberden's node">Heberden's node</a></li> <li><a href="/wiki/Bouchard%27s_nodes" title="Bouchard's nodes">Bouchard's nodes</a></li> <li><a href="/wiki/Osteophyte" title="Osteophyte">Osteophyte</a></li></ul></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Spinal_disease" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Spinal_disease" title="Template:Spinal disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Spinal_disease" title="Template talk:Spinal disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Spinal_disease" title="Special:EditPage/Template:Spinal disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Spinal_disease" style="font-size:114%;margin:0 4em"><a href="/wiki/Spinal_disease" title="Spinal disease">Spinal disease</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Deforming</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinal_curvature" class="mw-redirect" title="Spinal curvature">Spinal curvature</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Kyphosis" title="Kyphosis">Kyphosis</a></li> <li><a href="/wiki/Lordosis" title="Lordosis">Lordosis</a></li> <li><a href="/wiki/Scoliosis" title="Scoliosis">Scoliosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Scheuermann%27s_disease" title="Scheuermann's disease">Scheuermann's disease</a></li> <li><a href="/wiki/Torticollis" title="Torticollis">Torticollis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spondylopathy" title="Spondylopathy">Spondylopathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">inflammatory</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Spondylitis" title="Spondylitis">Spondylitis</a> <ul><li><a class="mw-selflink selflink">Ankylosing spondylitis</a></li></ul></li> <li><a href="/wiki/Sacroiliitis" title="Sacroiliitis">Sacroiliitis</a></li> <li><a href="/wiki/Discitis" title="Discitis">Discitis</a></li> <li><a href="/wiki/Spondylodiscitis" title="Spondylodiscitis">Spondylodiscitis</a></li> <li><a href="/wiki/Pott%27s_disease" title="Pott's disease">Pott's disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">non inflammatory</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Spondylosis" title="Spondylosis">Spondylosis</a></li> <li><a href="/wiki/Spondylolysis" title="Spondylolysis">Spondylolysis</a></li> <li><a href="/wiki/Spondylolisthesis" title="Spondylolisthesis">Spondylolisthesis</a> <ul><li><a href="/wiki/Retrolisthesis" title="Retrolisthesis">Retrolisthesis</a></li></ul></li> <li><a href="/wiki/Spinal_stenosis" title="Spinal stenosis">Spinal stenosis</a></li> <li><a href="/wiki/Facet_syndrome" title="Facet syndrome">Facet syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Back_pain" title="Back pain">Back pain</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Neck_pain" title="Neck pain">Neck pain</a></li> <li><a href="/wiki/Upper_back_pain" class="mw-redirect" title="Upper back pain">Upper back pain</a></li> <li><a href="/wiki/Low_back_pain" title="Low back pain">Low back pain</a> <ul><li><a href="/wiki/Coccydynia" title="Coccydynia">Coccydynia</a></li> <li><a href="/wiki/Sciatica" title="Sciatica">Sciatica</a></li></ul></li> <li><a href="/wiki/Radiculopathy" title="Radiculopathy">Radiculopathy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Intervertebral_disc#Disease" title="Intervertebral disc">Intervertebral disc disorder</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Schmorl%27s_nodes" title="Schmorl's nodes">Schmorl's nodes</a></li> <li><a href="/wiki/Degenerative_disc_disease" title="Degenerative disc disease">Degenerative disc disease</a></li> <li><a href="/wiki/Spinal_disc_herniation" title="Spinal disc herniation">Spinal disc herniation</a></li> <li><a href="/wiki/Facet_joint_arthrosis" title="Facet joint arthrosis">Facet joint arthrosis</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medicine" title="Template:Medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medicine" title="Template talk:Medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medicine" title="Special:EditPage/Template:Medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Medicine" style="font-size:114%;margin:0 4em"><a href="/wiki/Medicine" title="Medicine">Medicine</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialties</a><br />and<br /><a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal surgery</a></li> <li><a href="/wiki/Digestive_system_surgery" title="Digestive system surgery">Digestive system surgery</a></li></ul></li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgery</a></li> <li><a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">Oral and maxillofacial surgery</a></li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedic surgery</a></li> <li><a href="/wiki/Hand_surgery" title="Hand surgery">Hand surgery</a></li> <li><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otolaryngology</a> <ul><li><small>ENT</small></li></ul></li> <li><a href="/wiki/Pediatric_surgery" title="Pediatric surgery">Pediatric surgery</a></li> <li><a href="/wiki/Plastic_surgery" title="Plastic surgery">Plastic surgery</a></li> <li><a href="/wiki/Reproductive_surgery" title="Reproductive surgery">Reproductive surgery</a></li> <li><a href="/wiki/Surgical_oncology" title="Surgical oncology">Surgical oncology</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplant surgery</a></li> <li><a href="/wiki/Trauma_surgery" title="Trauma surgery">Trauma surgery</a></li> <li><a href="/wiki/Urology" title="Urology">Urology</a> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li></ul></li> <li><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Internal_medicine" title="Internal medicine">Internal<br />medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a> / <a href="/wiki/Immunology" title="Immunology">Immunology</a></li> <li><a href="/wiki/Angiology" title="Angiology">Angiology</a></li> <li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></li> <li><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <ul><li><a href="/wiki/Hepatology" title="Hepatology">Hepatology</a></li></ul></li> <li><a href="/wiki/Geriatrics" title="Geriatrics">Geriatrics</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">Infectious diseases</a></li> <li><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and<br />gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" 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