In Great Britain and the United States 90%, or more, patients present over the age of sixteen. By contrast to the developing world, some 25-30% first develop symptoms in childhood. This specific difference between adult onset and childhood onset of disease relates to the fact that children tend to present, not with back pain, but with peripheral joint involvement - usually the knee, hip, ankle, or other large joints. Regarding the long-term prognosis, such young onset individuals are more likely to have persistent hip disease that can lead to a need for total hip replacement. Since this is now so successful there should be relatively little concern about such an eventuality.
This is the condition ofulcerative colitis or Crohn's disease, which in a few people overlap, with AS but is not caused by it. The symptoms are bouts of bloody diarrhoea, often with fever, weight loss, and an associated peripheral arthritis in some cases.
This is a group of symptoms which may lead on to AS. These are:conjunctivitis (red, gritty, painful eyes) or uveitis.
Our intestines contain bacteria which cause no harm and indeed help us to remain healthy. However, some infections from contaminated food cause diarrhoea, or in severe cases it's called dysentery. Some of these infections can start AS. It is a cause of great interest to research workers why some bacteria lead on to AS and others don't.
Syphilis and gonorrhoea do not cause AS. However, a separate group of infections known as 'NSU' (Non Specific Urethritis) includes an infection due to an organism called chlamydia. This causes urethritis and sometimes other features of Reiter's syndrome.
There is a skin condition calledpsoriasis which is also associated with AS. It can present with scaly patches in the skin which in some cases can be quite extensive. The scalp may be involved. It can also lead to a slightly different form of arthritis of the joints.
No two cases of AS are identical. The symptoms will come and go, varying in intensity. There is no warning as to when the next flare-up will occur and no indication as to when it will quieten down. Towards the age of fifty the attacks may become less frequent. In some cases this period of permanent remission will happen earlier in life. The severity of the stiffening associated with the condition will also vary. It is therefore important to maintain a good posture. Not all patients carrying out a regular exercise programme will maintain normal posture and mobility. However, the serious deformities of the spine can be prevented and mobility maintained. Those people who have lost an upright posture will find it difficult to come to terms with. Many of them have been greatly helped through the NASS Newsletter and coming into contact with others through their local NASS branch. Successful management of the condition requires co-operation between the doctor, the physiotherapist and the patient. Any notion that the patient might have of simply handing themselves over to the doctor, who will prescribe a magic pill, is not only erroneous but dangerous. It takes considerable will-power to carry out a regular exercise programme. The NASS branches around the UK enable members to exercise together under the supervision of a qualified physiotherapist, who has taken a special interest in the treatment of the condition. The growth of the NASS branches is now playing an increasing and important role in the management of the condition in this country.