ankylosing spondylitis /ang′kilō″sing/ , a chronic inflammatory disease associated with human leukocyte antigen B27, first affecting the spine and adjacent structures and commonly progressing to eventual fusion (ankylosis) of the involved joints. In extreme cases a forward flexion of the spine, called a “poker spine” or “bamboo spine,” develops. Also called Marie-Strümpell arthritis, Marie-Strümpell disease. See also ankylosis, rheumatoid arthritis. ▪ OBSERVATIONS: The disease primarily affects males under 30 years of age and generally follows a course of 20 years. There is a strong hereditary tendency. In addition to the spine, the joints of the hip, shoulder, neck, ribs, and jaw are often involved. When the costovertebral joints are involved, the patient may have difficulty in expanding the rib cage while breathing. Ankylosing spondylitis is a systemic disease, often affecting the eyes and heart. Many patients also have inflammatory bowel disease. ▪ INTERVENTIONS: The chronic nature of the disease requires a coordinated team approach. The medical aim of treatment is to reduce pain and inflammation in the involved joints, usually with nonsteroidal antiinflammatory drugs and tumor necrosis factor drugs. Physical therapy helps keep the spine as erect as possible to prevent flexion contractures. The occupational therapist examines surroundings (home, school, work environment) to determine the impact of the disease on everyday functions and responsibilities. Nursing care must focus on management of the medication regimen and coping with the chronic nature of the disease. In advanced cases, surgery may be performed to straighten a badly deformed spine. ▪ PATIENT CARE CONSIDERATIONS: Care is complex and the patient should be encouraged to take an active role in management. Support groups are an important resource.
