Investigations and Management of Ankylosing Spondylitis (AS)

Q: My son broke his L5 vertebra two years ago and has been suffering chronic debilitating pain ever since. Many specialists including spine consultant, neurologist and orthopedic surgeons saw but of no avail. Pain management specialist did an epidural steroid injection and he could barely make it home. He was screaming for five hours in pain. That was the start of a year of debilitating pain. He could not go to school, let alone get out of bed. He was developing seizure like spasms. He also had lower limb pain so he would just be screaming. We had many ER visits, and they started to tell us it was all in his head. I knew it wasn’t.

His back doctor discovered an year later that the fracture never healed. He thought that was causing the pain, so he did another injection in his spine using a different formula than the pain management specialist used. That worked for about 3 days but he was in pain again.

He got his first appointment with a rheumatologist who spent a couple of hours with him. She reviewed his old scans and X-rays and saw clear evidence of something called Bamboo spine or Ankylosing Spondylitis, AS for short. She gave him a shot in her office to reduce his overactive immune system from attacking his bones, and thereby causing the bone spurs all over his body. He is supposed to take it once a month and that will help with the infection and immunity. She has not done the DNA of fecal test to confirm the diagnosis of AS. But she says that she has never seen a clearer or more severe case of this in a young boy of his age.

What are the side effects of these injections? He immediately felt better for about three days but now the pain is creeping back. He can not work and can barely go to JC. He needs help with almost everything he does at times. Will these injections eventually help him to lead a normal life? He’s only 18 and has missed out so much for the past two years. Do you know much about this bamboo spine? Is it similar to Lupus?
– By Karrie

Reply:

The disease is similar to lupus in its nature. Both belong to the category of autoimmune diseases. In such cases, the body develops antibodies that act to destroy one’s own body cells.

Normally, antibodies are produced as a defense against diseases. They fight against the germs and defend the body.

Why autoimmune disorders are caused is not fully understood. However, some degree of genetic predisposition has been observed.

It would to necessary to confirm the diagnosis of ankylosing spondylitis. Rheumatologist is the right person to deal with the disease.

Confirming the Diagnosis

The diagnosis is confirmed by:

• Examination of the patient and blood work, showing negative RF and ANA
• Increased ESR and other acute-phase reactants
• Presence of HLA B-27
• X-ray showing fusion of vertebrae known as bamboo spine.

The DNA test of HLA B27 is essential.

The treatment is targeted to reduce the production and effects of those destructive antibodies. Doctors use steroid and other similar drugs for the purpose. Though such medications do have their side effects, there is no other option. The antibodies cannot be left as such to slowly destroy body tissues!

A good rheumatologist uses these medications judiciously. Steroids can be coupled with other medications too, to provide relief.

You may read here more about ankylosing spondylitis and seronegative spondyloarthropathies.

Side Effects of Epidural Steroid Injections

Complications of the procedure

• Infection, at the site of puncture.
• Post puncture headache (also called a spinal headache)- This may take a week or so to improve.
• Bleeding from the puncture site.
• Nerve damage due to wrong insertion of the needle

Side Effects of Steroid Medication

• There is a transient decrease in immunity because of the suppressive effect of the steroid. The patient needs to take precautions like, avoiding going to crowded places, use clean bathrooms and laundry, etc.
• Cataracts in the eyes may be there on long term use.
• Stomach ulcers
• Changes in blood sugar levels

For more information on the topic, you may go to one of these web resources: National Library of Medicine’s article  on this joint disease (AS) and Medline Plus information on ankylosing spondylitis.

Take Care,

Buddy M.D.