Ankylosing spondylitis (AS, from Greek ''ankylos'', bent; ''spondylos'', vertebrae), previously known as Bechterew's disease, Bechterew syndrome, and Marie Strümpell disease, a form of Spondyloarthritis, is a chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroilium in the pelvis, causing eventual fusion of the spine.
It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.
Three men are diagnosed with AS for every one woman; the overall prevalence is 0.25%. Many rheumatologists believe the number of women with AS is underdiagnosed, as most women tend to experience milder symptoms.; however, skeletal evidence of the disease (ossification of joints and entheses primarily of the axial skeleton, known as "bamboo spine") was first discovered in an archaeological dig that unearthed the skeletal remains of a 5000-year–old Egyptian mummy with evidence of "bamboo spine".
The anatomist and surgeon Realdo Colombo described what could have been the disease in 1559, and the first account of pathologic changes to the skeleton possibly associated with AS was published in 1691 by Bernard Connor. In 1818, Benjamin Brodie became the first physician to document that a patient believed to have active AS had accompanying iritis. In 1858, David Tucker published a small booklet which clearly described a patient by the name of Leonard Trask who suffered from severe spinal deformity subsequent to AS. In 1833 Trask fell from a horse, exacerbating the condition and resulting in severe deformity. Tucker reported:
This account became the first documented case of AS in the United States, since its indisputable description of inflammatory disease characteristics of AS, and the hallmark of deforming injury in AS.
It was not until the late nineteenth century (1893-1898), however, when the neurophysiologist Vladimir Bekhterev of Russia in 1893, Adolph Strümpell of Germany in 1897, and Pierre Marie of France in 1898, 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 Bechterew Disease or Marie–Strümpel Disease.
The majority of patients with AS exhibit the HLA-B27 antigen and high levels of immunoglobulin A (IgA) in the blood. The HLA-B27 antigen is also expressed by Klebsiella bacteria, which is found in high levels in the feces of AS patients. A theory suggests that the presence of the bacteria may be a trigger of the disease, and reducing the amount of starch in the diet (which the bacteria require to grow) may be of benefit to AS patients. A test of this diet resulted in reduced symptoms and inflammation in patients with AS as well as IgA levels in individuals with and without AS. Further research is required to determine if diet changes may have a clinical effect on the course of the disease.
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