More questions answered about AS

Does AS affect other joints?
AS sometimes causes aching, pain and swelling in the hips, knees and ankles. Indeed, any joint can be affected. In most cases the pain and swelling will settle down after treatment. It is particularly important to stretch the hip joint to prevent stiffening in a bent position making you lean forward. The heel bone can become particularly troublesome causing pain in two areas. Most common is the under surface, about three centimetres from the back of the foot. This is called plantar fasciitis and can last for many weeks. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. It may respond to an insole for the shoe designed to take weight off that part of the heel. The less common posterior heel pain arises at the back of the heel where the Achilles tendon is attached to the heel bone. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. Pressure from the shoe may aggravate the pain.

I have found that squeezing the sides of my heel (vice grips are my tool of choice) or rolling my heel on a hard ball (like a baseball) very effective in dealing with heel pain. I only recently found out from a rheumatologist that my heel pain was associated with AS. Luckily I have not experienced this symptom for several months.

How does AS affect the lungs?
AS may affect the rib joints and the muscles between the ribs making breathing, sneezing, coughing or yawning painful. As a result, the lungs fail to become fully ventilated. Sometimes the lungs may get scarred, a condition know as apical pulmonary fibrosis. This will show up on an X-ray but does not usually cause any symptoms. In the late stages of AS the chest wall may become quite fixed and affect air entry in and out of the lungs. This does not mean you stop breathing! The diaphragm muscle continues to work and your stomach moves in and out as you breathe. Large meals and tight clothing will increase the effort of breathing so you may find it more comfortable to avoid these. It is also vital to avoid smoking since this will not only make breathing more difficult but it could cause potentially serious lung and chest infections.

What is the risk of passing it on to my children?
If a parent has AS there is a 50% chance that the B27 gene will be passed on to a child. However, not everyone with the B27 gene will go on to develop AS. Overall, the likelihood of your child developing AS will be less than 1 in 10 (or 1 in 5 if B27 positive). The chance of a child inheriting the condition from a grandparent will be less than 1 in 20. Should your child develop early symptoms of AS, it is advisable to ask your family physician for a referral to a rheumatologist.

Are any other diseases associated with AS?
A skin condition called psoriasis is associated with AS. Psoriasis causes scaly patches on the skin and scalp. It can also lead to a slightly different form of arthritis. A sexually acquired infection known as Non-Specific Urethritis (NSU) can be caused by an organism called chlamydia. This leads to urethritis and sometimes other features of Reiter's Syndrome. Ulcerative colitis or Crohn's disease are also related to AS but are not caused by it. The symptoms are bouts of bloody diarrhoea, often with fever, weight loss, and an associated peripheral arthritis in some cases.

What is the end result?
AS seems to affect everybody slightly differently. In general, though, you will probably find that the symptoms come and go over many years. In the classic case, the lumbar spine can become stiff, caused by the growth of additional bone, as can the upper spine and neck. If you pay attention to your posture, exercise regularly and avoid the stoop associated with the condition, you can prevent this from becoming too serious.