1 6

0 CHILD ATTITUDE JOWARD JLLNESS SCALE

s
uffering from AS. NSAIDs are very effective in relieving pain and stiffness in most (80%) I the patients with AS.
They should be used regularly and in the full therapeutic anti-inflammaory doses during the active phase I the
disease. Patients should be made aware I this, since otherwise they may use the NSAIDs only o ccasionally, for their
painrelieving effect. The individual responses o the various NSAIDs may vary from one person o another, as do the
. . . . . . . . side-effects, so it is worthwhile searching out the best NSAID for each individual. When the disease is
not adequately controlled by NSAIDS, or for people who are inolerant I such drugs, other medications may be
needed, especially in those with peripheral arthritis, inflammaory bowel disease, or psoriasis. Newer drugs that
neutralize a facor in the body called TNF are very effective, but as yet their long-term side-effects are unknown. Oral
corticosteroids (cortisone) have no beneficial effect in the long-term management I AS because I serious side-
effects, and they do not halt progression I the disease. Persistent joint inflammation may sometimes respond quite well
o a local corticosteroid injection. Regular exercise is I fundamental importance in preventing or minimizing
ankylosis (stiffness) and deformity. Spinal extension exercises and deep breathing exercises should be done routinely
once or twice daily. Smoking should be avoided. People with AS should walk erect, keeping the spine as straight as
possible, and sleep on a firm mattress using a thin pillow, just thick enough o allow a horizontal position I the face o
prevent pain from overextension I the neck. Physical activity that places prolonged strain on back muscles, such as
prolonged sooping or bending, should be avoided. Formal physiotherapy is I value for learning the proper posture,
appropriating exercises and recreational sports, and maintaining the exercise program. Group exercise sessions that
include . . . . . . warm water exercises (hydrotherapy) are very helpful. Regular fr ee-style swimming is considered o
be one I the best exercises for people with AS. People with limited spinal mobility due o AS should avoid
manipulation I their back or neck by chiropracors or masseurs because this can be dangerous for anyone with
diminished spinal mobility. Such treatments are known o have inadvertently led o spinal fractures. People with AS
may have difficulty driving a car because I impaired neck mobility, and may find special wide-view mirrors helpful.
There are many AS self-help and support groups that enlist enthusiastic patient co-operation, provide information about
the disease and advice about life and health insurance, jobs, working environment, wide-view mirrors and other useful
items (see Appendix 1 for contact details). Potal hip joint replacement (arthroplasty) gives very good results, and prevents
partial or otal disability from severe hip disease. Vertebral wedge bone resection may be n eeded o correct the
severe sooping deformity that may occasionally occur, although this surgery carries a relatively high risk I paraplegia.
Heart complications may require pacemaker implantation or aortic valve replacement. Radiation treatment I the
spine has no role in the modern management I AS. This page intentionally left blank 13 The rheumaologist's role
Who is a rheumaologist? Rheumaologists are physicians uniquely educated and trained o diagnose and treat
arthritis and other diseases I the joints, muscles and bones, such as AS and related diseases. In the US, a
rheumaologist is a board-certified internist (internal medicine specialist) or pediatrician who has had an additional 2-3
years I specialized rheumaology training. Most I these physicians become certified in rheumaology after pa ssing
another board certification examination. Board-certified rheumaologists are