Ankylosing Spondilitis

[TyroneShoes]

Anyone know of a connection to SA?

I have the genetic marker, often the symptoms. Also, severe SA.

[PaulaO2]

I could see how someone with the fused, bent neck would be more prone to obstructive apnea events.

I found an article in PubMed that kinda connected the length of time someone had the disease and their age to their chances of having sleep apnea.
http://www.ncbi.nlm.nih.gov/pubmed/19223282

I found another article elsewhere that dealt with the poor sleep of folks with AS. They concluded that sleep apnea was not a significant finding in their study.
http://www.sciencedirect.com/science/art...6412000038

So I would assume then that "simply" having the gene for it would not cause one to have sleep apnea nor make sleep apnea worse.

[DocWils]

It would depend where the spondilitis is located. If in the cervical spine, there would be some pressure on the nerves, some of which could cause CA type events, however, OSA events from spondilitis would depend on how the neck is deformed and would be positional in nature - this would be corrected with treatment of the misalignment via PT, usually TENS treatment. Aortic insufficiency is a far greater risk than Apnoea, but there is a small body of evidence that shows "bamboo spine" in the upper thoracic/cervical region can influence breathing at night. As of yet the sample remains too small to be clinically significant, but more research is being done in this area. AS in the thoracic spine can have a full-on effect on normal day time respiration, but the effect is the same at night and while it might be considered Apnoea, standard treatments with CPAP would not apply, as it is not sleep related and not obstructive or neurological in nature.

There is no clear relationship to any genetic marker - you would need the full blown syndrome in the correct region of the spine for it to have any significant effect on your respiration, day or night time. A marker alone is meaningless in this context.

[TyroneShoes]

Not meaningless if you also have symptoms, I would guess.

I get unexplained hip joint pain, one side or the other, about once a year. Goes away in a couple days.

I have a tendency towards iritis (not in a while, thankfully), and have had some bad occurrences of that.

I have lower or upper back pain a couple times a year (not sure if it is related)

I do not have the straightest back, never have. But then I am not that much of an outlier; no HB of ND, at least. I can't lie down flat on an exam table without a pillow, and the dentist's chair is uncomfortable because I can't straighten my back. I sleep with my upper half inclined, lots of pillows, and some under my knees, just to stay comfortable, so I guess I am not exactly normal, either.

I do have the marker, as does my mother who has suffered a lot more than I (and also snores and has COPD at 92), and my sister, who has also had symptoms. My grandfather (her father) was so bent over he had to bend his knees to look straight ahead. But he was probably in his late 60's when I first met him. AS didn't slow him down; he died of other causes at 84.

Not complaining; I love life, and I am very grateful that I have this and not something worse.

[me50]

Not meaningless if you also have symptoms, I would guess.

I get unexplained hip joint pain, one side or the other, about once a year. Goes away in a couple days.

I have a tendency towards iritis (not in a while, thankfully), and have had some bad occurrences of that.

I have lower or upper back pain a couple times a year (not sure if it is related)

I do not have the straightest back, never have. But then I am not that much of an outlier; no HB of ND, at least. I can't lie down flat on an exam table without a pillow, and the dentist's chair is uncomfortable because I can't straighten my back. I sleep with my upper half inclined, lots of pillows, and some under my knees, just to stay comfortable, so I guess I am not exactly normal, either.

I do have the marker, as does my mother who has suffered a lot more than I (and also snores and has COPD at 92), and my sister, who has also had symptoms. My grandfather (her father) was so bent over he had to bend his knees to look straight ahead. But he was probably in his late 60's when I first met him. AS didn't slow him down; he died of other causes at 84.

Not complaining; I love life, and I am very grateful that I have this and not something worse.

your positive attitude will help you along the way!

[PaulaO2]

My step-father had AS. Was stuck in the typical bent spine from mid thoracic up. He worked for Mobil Oil and was climbing the big tanks way into his 60s. Great guy except for his love of vodka.

I do doubt that having AS would cause OSA. I can see where it could make it worse but not cause it.

[DocWils]

Your symptoms as described would not be significant in an OSA diagnosis, despite your aches and pains. At this point there would be other causes, none related to AS. However, it is good to be aware of the possibility of AS in terms of your future development and in treating aches and pains as you experience them and any possible skeletal changes. Your positive attitude is the best medicine at the moment, and I encourage you to continue to think positively. You are treading in my territory now (I was an orthopaedic surgeon) and I can tell you that there are several new treatments in development so while there is at the moment little that can be done for symptomatic patients, it is possible that in around ten to fifteen years or so, some of these new treatments will be in circulation, and you may find that your AS will be, if not a thing of the past, at least something manageable. When I began practising medicine, AS was considered exclusively part of orthopaedic medicine, but it has been moved into the regions of medicine that deal with auto-immune diseases. Many of these still require considerable orthopaedic consultation and treatment, but the research emphasis now is not on treatment at the later stages, but at prevention from the early stages, and that is an encouraging sign, as we are coming to far greater understanding of how auto-immune diseases develop and how to combat them.

On terms of how AS is affecting your OSA at the early stages you describe, I would opine that it has no effect at all. As I said, you would need to be very specifically stricken for it to impact on you in that way.

Keep up the positive attitude and don't let it slow you down.

[TyroneShoes]

Great info, all, and thanks. From what you say I should at least mention this when getting a checkup, but my understanding of this is that it affects folks mostly when in their forties, and seems to wane once you get significantly beyond that. That has seemed to be the pattern for me, although a nice straight back is something I have only ever been able to fantasize about. My Q was more just curiosity than anything.

My apologies for not getting back (forgot to subscribe, I guess).

But then my hypochondria is now urging me to google Aortic Insufficiency.

My dad was also an orthopedic surgeon, yet ironically we never discussed this (the cobbler's children have no shoes).

[DocWils]

My family can't stop bugging me for free medical advice - and worse still, I give it freely instead of keeping stum. As such, at family gatherings there is a line up of people wanting to talk to me about this wee hurt and that weird boil and whatever. The husband of my wife's first cousin is just moving into the Chief of Medicine post at one of the hospitals in one of the middle sized towns outside of Zurich, and whenever we get together, we have a rule - ten minutes shop talk at the beginning, and then only politics, philosophy, religion and kids. Lots about kids.

Just curious - were you already told of your genetic marker while your father was around (assuming from the "was" that he is no longer on this plane)?

On the whole, I think you need not look up Aortic Insufficiency until you are strongly symptomatic - you will only freak yourself out for nothing. At this point, as I said, great strides are being made in heading off the worst of AS via treating the root cause of it, and in ten years there might be a lot of major advances - plenty of time for you, as this is a slow developing disease at first.

And yes, please mention all this in your check-up. Your doctor can't help if you don't give him the best possible information. Write everything down before hand in bullet point format, then you have a crib sheet to work from when you talk to him and nothing gets left out. I guess your dad didn't mention that one, either.

There is evidence that in some patients it stabilizes after 40, but not in all - it is an autoimmune disease, and that means it is heavily dependent on factors that are hard to track - this is where you have the Dr. House types playing detective. Diet, exercise, environment, attitude all play a significant part in the progress of the disease. Genetics is only one factor - it points to the potential, but the trigger factors on whether the gene is expressed (meaning it does what we hoped it might not do - develop into a disease or syndrome) is complex and in each individual the case is quite different as to whether it is expressed or not. In the same way, there is considerable variance as to when that expression seems to end, or if it does, or goes dormant, or what. Auto-immune diseases are a bitch and a half for medicos to figure out. I have a dear friend, perhaps the true love of my life, had I not met She Who Must Be Obeyed, who has, since her teens, gone from one auto-immune disease to another - she is now 53 and should have been dead at least ten years from Multiple Myeloma, but she is still in there batting, helping people in Cambodia. She should have been crippled or dead 20 years already from MS, she was pregnant 8 times, but Erythroblastosis fetalis killed all 8 fetus, the list goes on - each one expressed itself, then spontaneously went into remission, and the next one came out - why she continues to go from one autoimmune disease to the next is a mystery, yet she survives each one, because at some point they seem to turn off in her. No one can figure it, and I honestly am beginning to believe that it has something to do with her attitude and her love of life and of the living, and maybe her bloody-mindedness. So, take her as a lesson - you can't be sure how this will play out, and while it is alright to be informed about possible outcomes, the actual ones will be unique to you. In the meantime, my best advice, beyond what I have already given you, is eat healthy, keep the weight down, reduce your environmental and dietary factors that may exacerbate any incipient diseases, and stay positive and proactive. And don't smoke or anything stupid like that.

Good luck.