It is important for people who have AS to be aware that they might be starting an attack of iritis oruveitis. Forty percent of people will develop this problem on one or more occasions. Usually the first symptom is a slight blurring of vision in one eye. However, whether this is noticed or not, in most cases the main symptom is sharp pain, together with a dramatically bloodshot eye. It is important to receive prompt treatment. To save time, it is better to go to the casualty department of your local hospital and be treated by the ophthalmology team. In larger towns and cities there may be an eye hospital, in which case go there. Not all family doctors are aware of the connection between AS and uveitis, and many members of NASS have also experienced similar problems in the casualty department of hospitals. Delay can cause permanent damage. Usually the pain will subside within hours after the course of self-administered drops has started. In most cases, this will last for two or three weeks. It is possible for the eye condition to precede the onset of AS in the spine, but this is uncommon.
Heart involvement does occur in ankylosing spondylitis, but in most cases where it is involved it is so mild that it is difficult to detect. It can affect particularly the aortic valve which can leak and more commonly it can affect the induction of electrical activity within the heart, but usually any such problems are unnoticed by the person with the condition. On the very rare occasion when treatment is needed surgical intervention may be helpful.
AS affects the rib joints and intercostal muscles (muscles between the ribs) which means that breathing, sneezing, coughing or yawning can be painful. This results in the lungs failing to become fully ventilated, and one should therefore do breathing exercises (see schedule of daily exercises). This encourages your lungs to regain their original volume. The lungs can sometimes get scarred. This problem shows up on a radiograph. The condition usually gives rise to no symptoms. In the "old days" TB was common and it was felt that AS predisposed sufferers to lung infections. There is no evidence to suggest that AS makes you more susceptible to chest infections. For all people with ankylosing spondylitis it is of paramount importance to avoid smoking. The reason for this is that in the late stages of the disease the chest wall may become quite fixed and therefore air entry in and out of the lungs will be affected. Clearly smoking can make the situation much worse and allow development of other infections and lung diseases. In other words, smoking is dangerous for all of us but the person with ankylosing spondylitis is at even greater risk.
There are a few other conditions associated with ankylosing spondylitis, and some people will have an overlap with one or more of them. For example, juvenile arthritis, inflammation of the bowel, Reiter's syndrome,psoriasis and some infections of the bowel can predispose to AS. There are some sexually acquired infections which can also lead on to AS.
Interestingly theX-ray changes in the spine of primary ankylosing spondylitis look very much like spondylitis associated with inflammatory bowel disease. By contrast, psoriatic spondylitis and that associated with Reiter's disease tend to look somewhat different, with more fluffy radiological changes. Of interest is that enteropathic spondylitis (i.e. that following inflammation of the bowel) has an equal sex distribution, whereas psoriatic spondylitis favours men in a ratio of 4 to 1 compared to the general background of ankylosing spondylitis of 2.5 to 1.
Children can develop arthritis at any age, but boys more than girls from the age of 10 years many get swollen knees or painful hips. In later life (i.e. in the twenties or thirties) they may get other features of AS which can be anticipated if they possess theHLA B27 antigen.