Pathology

Pathology:
Conditions: Task 2 – Ankylosing Spondylitis
Victoria Walden
Due 18th May 2009

Description of Ankylosing Spondylitis:

Ankylosing means joining together or stiffening .
Spondylitis means inflammation of the vertebral bones of the spine.
Ankylosing spondylitis is a chronic, systemic, inflammatory arthritis leading to calcification and fusion (ankylosing) of the joints, usually the spine and scaroiliac joints (Salvo, S, G. 2008, p.132). This type of arthritis often runs in the family genes, also men are three times more likely to get this disease.
This disease is usually diagnosed in young adults with a peak onset between 20 and 30 years of age and can range from a mild to more severe disease in patients.

Etiology:

Ankylosing spondylitis is considered an autoimmune disease with the genetic basis (genetic basis means that is type of arthritis runs in the family genes, therefore if AS is common in a family, then it is more likely that in that family AS will occur)
With the disease this is the process of what occurs:
· Inflamed joints become infiltrated with inflammatory cells such as fibroblasts, repair begins.
· Collagen is laid down and organised into fibrous scar tissue.
· Tissues undergo the process of calcification and ossification (forming bone), leading to joint fusion and loss of flexibility.



Incidence:

One out of 10,000 people has Ankylosing spondylitis. It affects males more than females and usually is found between the ages of 20 and 40 (Springhouse, 2005).
It may develop in children younger than 10 years of age.

Signs and symptoms:

· This Disease affects the sacroiliac joints, intervertebral disk spaces and costo-vertebral joints commonly.
· It rarely affects the larger synovial joints e.g. hips, knees, shoulders.
· The spine becomes rigid and appears like bamboo, like in X-rays (Dr. Premkumar, K. 2000).
· Disease has exacerbations (can be made worse)and remissions (slight reduction of disease).
· Pain becomes worse when the body is at rest – pain reduces by mild activity.
· Patient complains of constant or irregular low back pain.
· Approximately 30% of this disease shows signs of systemic nature, such as fatigue, weight loss and low grade fever.
· 30% experience bowel inflammation with diarrhoea, eye inflammation and light sensitivity.
· Pain may radiate to the thigh area
· Through reduced movement of vertebral column the curvature of lumbar area is slowly lost.
· In the late stages of disease the spine becomes fixed.
· If costo-vertebral joints are fixed it can have an effect on lung volume.
· Kyphosis (hunchback) occurs when thoracic or cervical areas are affected and the weight of the head compresses the vertebral bodies therefore bends the spine forward, Head becomes hyperextended to maintain field of vision.



Indications and contraindications for massage therapy:

· Client should be positioned to what feels comfortable with plenty of support from pillows.
· Clients with Kyphosis need extra neck support.
· Pillow under knee can relieve tension on hamstrings, also cause pelvis to tilt backwards and straighten lumbar spine.
· From this disease Osteoparosis is common, which can lead to compression fractures
(Salvo, S, G. 2008, p.132).
· Ribcage expansion during inspiration is reduced if costo-vertebral joints are fused therefore client may experience breathing difficulties.
· AIM: Retain mobility of the joints, strengthen weak muscles and stretch tight muscles.
· YES: Gentle massage to the back and limbs.
· YES: Hot packs will help ease pain
· NO: Do not forcibly mobilize ankylosed joints.
· NO: No spinal manipulation
· NO: No deep pressure as osteoporosis is common.
· NO: Avoid massage to inflamed areas
· Advice client to sleep in supine position if possible
· Encourage client to do breathing exercises to regularly move the thorax (help breathing)
· MAJOR: Client maybe on painkillers therefore giving the wrong reading to pain scale.
· Address any other medical conditions e.g. osteoarthritis in treatment plan
· Physician consulted in clients with severe deformities.

References:

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Professor, Dougadlas, M. (2005). Orphanet. Ankylosing spondylitis. May, 9th, 2009, from www.orpha.net/data/patho/GB/uk-Ankylosing-spondylitis.pdf

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists, (2nd ed.). Elsevier Health Science.

Wikipedia, Retrieved May, 9th, 2009 from http://en.wikipedia.org/wiki/ankylosing_spondylitis

Springhouse. (2005). Professional Guide to Diseases, (8th ed.). Lippincott: Williams & Wilkins.