In this Section:
The Austin Spondylitis Clinic was established in 2004 as one of the few centres in Australia committed exclusively to the care and treatment of patients with ankylosing spondylitis. To date, we have treated over 550 patients with ankylosing spondylitis.
Goals of the ASC
¨ To provide comprehensive and multidisciplinary patient care in an academic setting of research and education
¨ To advance our understanding of ankylosing spondylitis through clinical research projects and collaboration with basic scientist colleagues
¨ To educate general practitioners and other health professionals regarding early identification and management strategies for ankylosing spondylitis
¨ To raise awareness of ankylosing spondylitis in the wider community and to support services for individuals with the disorder.
What is Ankylosing Spondylitis?
Ankylosing = stiffening or joining together
Spondylitis = inflammation of the vertebrae
Ankylosing spondylitis (AS) affects approximately 1 in 200 people and is a form of arthritis that mainly affects the sacroiliac (SI) joints and the spine. It usually begins between the ages of 15 and 40 years although the diagnosis is often delayed.
What else can AS do?
About 50% of AS patients develop arthritis of limb joints such as the shoulders, hips and knees. Inflammation in areas where tendons insert into bone (called enthesitis) such as the heel and ribcage frequently occurs. Less commonly, psoriasis occurs and inflammation affects the eye (uveitis or iritis) and bowel (colitis).
How are day-to-day activities affected?
People with AS commonly complain of pain, stiffness and fatigue. In more severe cases, there is loss of mobility, ability to work and general independence. Approximately 70% will develop some x-ray fusion of the spine after a period of 10-15 years.
What about HLA-B27?
HLA-B27 is a normal genetic variant occurring in about 8% of Caucasians. Among such individuals, only about 12% will develop AS or a similar condition. Approximately 90% of people with AS are HLA-B27 positive. This gene alone does not cause AS and other important genes predisposing to AS have been recently identified. It is likely that AS is brought on by an unknown trigger in a genetically-predisposed person.
What about the risk to family members?
A first degree relative (child, sibling or parent) of an individual with AS has about a 30% chance of developing AS if they have HLA-B27. An identical twin of someone with AS has a 60% risk while the risk to a non-identical twin is about 20%.
What is ‘axial spondyloarthritis'?
This is a term commonly used to describe individuals with symptoms of AS who do not have x-ray abnormalities of the SI joints. MRI abnormalities occur before x-ray changes at the SI joints and are commonly seen in axial spondyloarthritis.
Can one predict the long term outcome in AS?
The long term course is variable but usually parallels the severity of symptoms over the first 10 years of disease. Recognised predictors of more severe AS in the long-term include early age at onset of symptoms, hip involvement, eye inflammation and smoking.
Is there effective treatment for AS?
The cornerstone of treatment for AS is daily exercise and anti-inflammatory medicines (e.g. Indocid, Celebrex, Naprosyn, Mobic, Voltaren, Nurofen, Feldene). For many patients with AS, TNF medicines have dramatically improved symptoms, spinal mobility and day-to-day functioning.
How important is exercise for AS?
A daily exercise program is critical for maintaining good posture, spinal mobility and daily functioning. If possible, the exercise program should be reviewed by an expert physiotherapist.
How good are anti-inflammatory medicines?
Anti-inflammatory medications work reasonably well in controlling pain and stiffness in AS. Some patients, however, can develop intolerable side effects.
What about prednisolone, methotrexate (Methoblastin®) and sulfasalazine (Salazopyrin®), and leflunomide (Arava®)?
Some patients with AS are treated with these medications although they work less well than in rheumatoid arthritis. They work best for peripheral arthritis (arthritis of the limb joints).
What are TNF medicines?
TNF stands for tumour necrosis factor which is a molecule activates the inflammatory process causing many of the features of AS. These treatments inhibit the effects of this molecule. There are four TNF medicines available for active AS: infliximab (Remicade®), etanercept (Enbrel®), adalimumab (Humira®) and golimumab (Simponi®).
How are TNF medicines given?
Remicade is administered via an intravenous (into the vein) infusion every 6 weeks. Enbrel, Humira and Simponi are given by a self-administered subcutaneous (under the skin) injection weekly, fortnightly and monthly respectively.
What are possible side effects of TNF medicines?
Recognised risks include infection (particularly tuberculosis in those previously exposed to TB), low blood counts, liver function test abnormalities, multiple sclerosis, heart failure, lupus, and possibly certain cancers. You will need to discuss the benefits and risks of TNF medicines with your rheumatologist before considering these treatments.
How does one obtain TNF medicines under the Pharmaceutical Benefits Scheme (PBS)?
After a 3-month course of exercise and at least two anti-inflammatory medicines, your rheumatologist needs to identify ongoing symptoms of active disease, reduced spinal mobility, x-ray changes at the sacroiliac joints, and an elevated ESR and/or CRP. Your rheumatologist can let you know whether you satisfy these requirements.