Patho Puzzler: Unlocking the puzzle of ankylosing spondylitis
Richard L. Pullen Jr., EdD, MSN, RN
Claudia Reed MSN, RN
Mark E. Rowh MA, CNMT, RTR

Nursing Made Incredibly Easy!
February 2013 
Volume 11  Number 1
Pages 12 - 17
  PDF Version Available!

Often referred to as arthritis of the spine, ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects the sacroiliac (SI) joints, spine, and peripheral joints. The name is derived from the Greek words ankylos, meaning stiffening of a joint, and spondylo, meaning vertebra. Spondylitis refers to inflammation of the spine or one or more adjacent structures of the vertebrae. Patients with AS don't test positive for antibodies, such as antinuclear antibody and rheumatoid factor. That's why AS is considered a seronegative spondyloarthropathy (any disease process of the spine).The enthesis-a site of insertion of a ligament, tendon, or articular capsule into bone-is the initial site of pathology in AS. The enthesis becomes inflamed (enthesitis), involving the SI joints, intervertebral disks, manubriosternal joints, symphysis pubis, iliac crests, trochanters, patella, clavicle, and calcanei (Achilles tendon). Enthesitis limits movement of these structures and results in stiffness, pain, and problems with mobility. Inflammatory and mobility problems may lead to compression and fractures of the intervertebral disks and other skeletal pathologies. Sometimes the inflammatory process in AS also affects other body organs.A: Patients who possess the human leukocyte antigen (HLA) B27 or who have a family history of AS are at increased risk for developing the disorder. The research evidence suggests that AS may be triggered by intestinal bacterial infections that lead to a systemic inflammatory response. Sometimes autoimmune disorders, including Crohn disease, ulcerative colitis, psoriasis, and Reiter syndrome, may coexist with the disorder. AS generally presents in young adults between ages 20 and 40, is twice as prevalent in White individuals compared with the general population, and affects men more often than women.A: Imaging studies, such as magnetic resonance imaging (MRI) and computed tomography (CT) scanning, are used to identify inflammation, spinal

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