Ankylosing Spondylitis

Q:  Can you please discuss ankylosing spondylitis? I have been diagnosed by a neurologist with this condition and am having problems reading and sewing. Bending my neck forward to do both causes my eyes to blur and sometimes results in severe headaches. I have been to an ophthalmologist whose solution was to elevate my reading material so as not to bend my neck forward. I would appreciate any information.

A:  Ankylosing spondylitis is an inflammatory arthritis that primarily affects the spine, although sometimes the hips and other joints can also be involved. Normal tissue that connects the vertebrae is gradually replaced by bone-like fibers, which fuse the spine and limit movement. Of unknown cause, the disease usually begins in early adult life before the age of 40 and affects men three times as often as women. Low back pain and morning stiffness are usually the initial symptoms. Activity or exercise usually improves the pain and stiffness. Diagnosis can usually be made by X-rays.

The course of the disease is quite variable with some people having very mild pain and others eventually having their whole spine fused. In women there is a tendency to less severe disease and more commonly involvement of just the cervical (neck) spine, as in your case.

Just recently though, I read about a woman in London who had such severe ankylosing spondylitis that her head was stuck pointing down on her chest. She couldn't look up or even eat and drink properly. Steven Gill, a neurosurgeon performed a 17-hour operation in which he essentialy detached her head from her spinal column, before repositioning and reattaching it. The patient is doing well and can now see in front of her although she said she has "a bit of a numb neck."

Fortunately your case is not that severe. Anti-inflammatory medication like Ibuprofen may ease the pain, but the cornerstone of treatment is an exercise program that helps maintain your posture and keeps your neck as mobile as possible.

Last but not least you can try "laugh therapy." Norman Cousins, now deceased, who was an editor of the Saturday Evening Post, also was diagnosed with ankylosing spondylitis. Determined to conquer the pain, he started watching videos of Candid Camera TV shows, and found that laughing eased the pain for several hours. His book about the experience, Anatomy of an Illness, should be available in your library.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.