MEDICAL MATTERS: To those meeting him for the first time, the late Dick Walsh appeared to have a breathing problem. In fact the much lamented political editor of this newspaper had battled ankylosing spondylitis, a rheumatic disease, since he was 27.
Ankylosing spondylitis is a painful, progressive disease that mainly affects the spine. The term ankylosing means "fusing together". Spondylitis is derived from the Greek word to describe the building blocks of the spine (spondylos). "Itis" is the medical suffix signifying inflammation.
It is important not to confuse spondylosis with spondylitis. Spondylosis is a term relating to "wear and tear" of joints; consequently it is quite common in older people. Ankylosing spondylitis describes an inflammatory process in which new bone is produced, eventually leading to fusion of joints. It usually starts in the late teens and early twenties.
Affecting one in 200 men and about one in 500 women, ankylosing spondylitis primarily destroys the joints of the lower spine. As bone replaces the elastic tissue in ligaments, the vertebrae fuse together. The same process affects joints linking the pelvis and the spine (sacroiliac joints). Less commonly, the inflammatory process targets the chest wall and neck. In women, the spine is less severely affected.
Although the exact cause of the disease is not known, it does have a strong genetic component. Over 90 per cent of ankylosing spondylitis patients carry the same gene-marker, Human Leukocyte Antigen B27 (HLA B27). It has been postulated that some outside process, such as infection, sets up the disease process in people with the HLA B27 gene. The inflammatory process starts, then subsides, only to be re-triggered when the infection recurs. Some bowel infections, in particular, seem to spark off spondylitis.
Typical symptoms of ankylosing spondylitis include:
- slow onset of back pain and stiffness over a period of weeks and months
- the stiffness and pain are worse in the morning and improve with exercise
- a pattern of the pain being worse after rest
- persistent fatigue is common
- night sweats and feeling feverish
Spondylitis can affect other joints, including the hips, knees and ankles. Heel pain may be caused by a thickening of the Achilles tendon and of another area just under the heel. If the hips are affected, exercises to prevent a permanent forward tilt of the body are important.
Ankylosing spondylitis can occasionally affect the heart, specifically the valve controlling blood flow into the body's main artery, the aorta. A leaking valve rarely results. The condition can also interfere with the transmission of the heartbeat throughout the heart muscle.
Blurring of vision, eye pain or a bloodshot eye may signal that the spondylosis has affected the eye. Again, inflammation is the culprit, but this time affecting the iris. About four in 10 people with ankylosing spondilytis will develop an eye problem.
As ankylosing spondylitis progresses, it can affect the lungs. There is no inflammation in the lungs per se, but breathlessness and pain on breathing are the result of the disease affecting the rib joints and the muscles between the ribs.
In some people, the chest wall loses its elasticity; as it becomes fixed it is difficult to fill the lungs properly. Because the diaphragm and stomach wall muscles compensate some air still goes in and out of the lungs. Large meals and tight clothing will make the breathlessness worse.
There is no cure for ankylosing spondylitis. Pain is managed using paracetamol and non-steroidal anti-inflammatory drugs, which also help stiffness. But probably the most important therapy is exercise.
Physiotherapy is vital: a combination of self exercise and occasional visits to a physiotherapist will help keep joints as flexible as possible. Regular exercise has been shown to slow the progress of the disease. And prolonged car driving is not kind to people with the condition. On long journeys, it is important to make frequent stops to limber up.
A key message for those with ankylosing spondylitis is "not moving leads to not being able to move". Wearing a back brace or a corset is one of the worst things you could do.
Local heat is very helpful in relieving pain and stiffness. A hot bath or shower first thing in the morning combined with stretching exercises is recommended.
And because of the reduction in capacity in the lungs as the disease progresses smoking is not a good idea.
Although ankylosing spondylitis is a life long disease it has been shown that those who take an active interest in their condition can positively influence its outcome. In the case of Dick Walsh he continued to work and remained the premier political analyst of his generation.
The Ankylosing Spondylitis Association of Ireland warns against the use of osteopathy, chiropractic and manipulation. The group produces a bi-annual newsletter and a guide book for patients.
It can be contacted at the Carmichael Centre, North Brunswick Street, Dublin 7. Telephone 01-8316678 or 01-8376614, email ASAI@oceanfree.net