Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 Nov;61(Suppl 3):iii3–iii7. doi: 10.1136/ard.61.suppl_3.iii3

Ankylosing spondylitis: introductory comments on its diagnosis and treatment

M Khan
PMCID: PMC1766733  PMID: 12381505

Full Text

The Full Text of this article is available as a PDF (200.4 KB).

Figure 1 .

Figure 1

Open in a new tab

Cumulative distribution of the age at disease onset (occurrence of the first spondylitic symptoms) and of the age at diagnosis for 920 male and 476 female patients with ankylosing spondylitis. Reproduced with permission from the authors and Current Opinion in Rheumatology from reference 5. Copyright © 2000 by Lippincott Williams & Wilkins.

Figure 2 .

Figure 2

Open in a new tab

The author, MA Khan, who has had AS for the past 46 years. Reproduced with permission of the author and Blackwell Publishing from MA Khan. Spondyloarthropathies. In: Hunder G, ed. Atlas of rheumatology. Oxford, UK, Blackwell Science; 1998:5.1–24.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altan L., Bingöl U., Karakoç Y., Aydiner S., Yurtkuran M., Yurtkuran M. Clinical investigation of methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol. 2001;30(5):255–259. doi: 10.1080/030097401753180318. [DOI] [PubMed] [Google Scholar]
  2. Amor B., Dougados M., Khan M. A. Management of refractory ankylosing spondylitis and related spondyloarthropathies. Rheum Dis Clin North Am. 1995 Feb;21(1):117–128. [PubMed] [Google Scholar]
  3. Amor B., Dougados M., Listrat V., Menkes C. J., Dubost J. J., Roux H., Benhamou C., Blotman F., Pattin S., Paolaggi J. B. Evaluation des critères des spondylarthropathies d'Amor et de l'European Spondylarthropathy Study Group (ESSG). Une étude transversale de 2,228 patients. Ann Med Interne (Paris) 1991;142(2):85–89. [PubMed] [Google Scholar]
  4. Amor B., Dougados M., Listrat V., Menkes C. J., Roux H., Benhamou C., Blotman F., Pattin S., Paolaggi J. B., Duquesnoy B. Are classification criteria for spondylarthropathy useful as diagnostic criteria? Rev Rhum Engl Ed. 1995 Jan;62(1):10–15. [PubMed] [Google Scholar]
  5. Baeten D., Kruithof E., Van den Bosch F., Demetter P., Van Damme N., Cuvelier C., De Vos M., Mielants H., Veys E. M., De Keyser F. Immunomodulatory effects of anti-tumor necrosis factor alpha therapy on synovium in spondylarthropathy: histologic findings in eight patients from an open-label pilot study. Arthritis Rheum. 2001 Jan;44(1):186–195. doi: 10.1002/1529-0131(200101)44:1<186::AID-ANR25>3.0.CO;2-B. [DOI] [PubMed] [Google Scholar]
  6. Baeten D., Van Damme N., Van den Bosch F., Kruithof E., De Vos M., Mielants H., Veys E. M., De Keyser F. Impaired Th1 cytokine production in spondyloarthropathy is restored by anti-TNFalpha. Ann Rheum Dis. 2001 Aug;60(8):750–755. doi: 10.1136/ard.60.8.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bakker C., Boers M., van der Linden S. Measures to assess ankylosing spondylitis: taxonomy, review and recommendations. J Rheumatol. 1993 Oct;20(10):1724–1730. [PubMed] [Google Scholar]
  8. Beckham J. C., Caldwell D. S., Peterson B. L., Pippen A. M., Currie M. S., Keefe F. J., Weinberg J. B. Disease severity in rheumatoid arthritis: relationships of plasma tumor necrosis factor-alpha, soluble interleukin 2-receptor, soluble CD4/CD8 ratio, neopterin, and fibrin D-dimer to traditional severity and functional measures. J Clin Immunol. 1992 Sep;12(5):353–361. doi: 10.1007/BF00920793. [DOI] [PubMed] [Google Scholar]
  9. Biasi D., Carletto A., Caramaschi P., Pacor M. L., Maleknia T., Bambara L. M. Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clin Rheumatol. 2000;19(2):114–117. doi: 10.1007/s100670050027. [DOI] [PubMed] [Google Scholar]
  10. Boers M. Predicting outcome of ankylosing spondylitis: prognosis or hindsight? J Rheumatol. 1994 Oct;21(10):1789–1790. [PubMed] [Google Scholar]
  11. Boonen A., van der Heijde D., Landewé R., Spoorenberg A., Schouten H., Rutten-van Mölken M., Guillemin F., Dougados M., Mielants H., de Vlam K. Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis. 2002 May;61(5):429–437. doi: 10.1136/ard.61.5.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Braun J., Bollow M., Neure L., Seipelt E., Seyrekbasan F., Herbst H., Eggens U., Distler A., Sieper J. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum. 1995 Apr;38(4):499–505. doi: 10.1002/art.1780380407. [DOI] [PubMed] [Google Scholar]
  13. Braun J., Bollow M., Seyrekbasan F., Häberle H. J., Eggens U., Mertz A., Distler A., Sieper J. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol. 1996 Apr;23(4):659–664. [PubMed] [Google Scholar]
  14. Braun J., Brandt J., Listing J., Zink A., Alten R., Golder W., Gromnica-Ihle E., Kellner H., Krause A., Schneider M. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet. 2002 Apr 6;359(9313):1187–1193. doi: 10.1016/s0140-6736(02)08215-6. [DOI] [PubMed] [Google Scholar]
  15. Breban M., Gombert B., Amor B., Dougados M. Efficacy of thalidomide in the treatment of refractory ankylosing spondylitis. Arthritis Rheum. 1999 Mar;42(3):580–581. doi: 10.1002/1529-0131(199904)42:3<580::AID-ANR27>3.0.CO;2-D. [DOI] [PubMed] [Google Scholar]
  16. Burgos-Vargas R., Petty R. E. Juvenile ankylosing spondylitis. Rheum Dis Clin North Am. 1992 Feb;18(1):123–142. [PubMed] [Google Scholar]
  17. Calin A. Clinical use of tolmetin sodium in patients with ankylosing spondylitis: a review. J Clin Pharmacol. 1983 Jul;23(7):301–308. doi: 10.1002/j.1552-4604.1983.tb02740.x. [DOI] [PubMed] [Google Scholar]
  18. Carette S., Graham D., Little H., Rubenstein J., Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum. 1983 Feb;26(2):186–190. doi: 10.1002/art.1780260210. [DOI] [PubMed] [Google Scholar]
  19. Clegg D. O., Reda D. J., Weisman M. H., Blackburn W. D., Cush J. J., Cannon G. W., Mahowald M. L., Schumacher H. R., Jr, Taylor T., Budiman-Mak E. Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 1996 Dec;39(12):2004–2012. doi: 10.1002/art.1780391209. [DOI] [PubMed] [Google Scholar]
  20. Coles L. S., Fries J. F., Kraines R. G., Roth S. H. From experiment to experience: side effects of nonsteroidal anti-inflammatory drugs. Am J Med. 1983 May;74(5):820–828. doi: 10.1016/0002-9343(83)91073-2. [DOI] [PubMed] [Google Scholar]
  21. Dougados M., Béhier J. M., Jolchine I., Calin A., van der Heijde D., Olivieri I., Zeidler H., Herman H. Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug. Arthritis Rheum. 2001 Jan;44(1):180–185. doi: 10.1002/1529-0131(200101)44:1<180::AID-ANR24>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
  22. Dougados M., Revel M., Khan M. A. Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation. Baillieres Clin Rheumatol. 1998 Nov;12(4):717–736. doi: 10.1016/s0950-3579(98)80046-0. [DOI] [PubMed] [Google Scholar]
  23. Dougados M., vam der Linden S., Leirisalo-Repo M., Huitfeldt B., Juhlin R., Veys E., Zeidler H., Kvien T. K., Olivieri I., Dijkmans B. Sulfasalazine in the treatment of spondylarthropathy. A randomized, multicenter, double-blind, placebo-controlled study. Arthritis Rheum. 1995 May;38(5):618–627. doi: 10.1002/art.1780380507. [DOI] [PubMed] [Google Scholar]
  24. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  25. Feldmann M., Brennan F. M., Maini R. N. Role of cytokines in rheumatoid arthritis. Annu Rev Immunol. 1996;14:397–440. doi: 10.1146/annurev.immunol.14.1.397. [DOI] [PubMed] [Google Scholar]
  26. Feldtkeller E., Bruckel J., Khan M. A. Scientific contributions of ankylosing spondylitis patient advocacy groups. Curr Opin Rheumatol. 2000 Jul;12(4):239–247. doi: 10.1097/00002281-200007000-00002. [DOI] [PubMed] [Google Scholar]
  27. Gorman Jennifer D., Sack Kenneth E., Davis John C., Jr Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med. 2002 May 2;346(18):1349–1356. doi: 10.1056/NEJMoa012664. [DOI] [PubMed] [Google Scholar]
  28. Granfors Kaisa, Märker-Hermann Elisabeth, de Keyser Filip, Khan Muhammad A., Veys Eric M., Yu David T. Y. The cutting edge of spondylarthropathy research in the millennium. Arthritis Rheum. 2002 Mar;46(3):606–613. doi: 10.1002/art.10041. [DOI] [PubMed] [Google Scholar]
  29. Günaydin I., Pereira P. L., Daikeler T., Mohren M., Trübenbach J., Schick F., Kanz L., Kötter I. Magnetic resonance imaging guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol. 2000 Feb;27(2):424–428. [PubMed] [Google Scholar]
  30. Kavanaugh A. F. Anti-tumor necrosis factor-alpha monoclonal antibody therapy for rheumatoid arthritis. Rheum Dis Clin North Am. 1998 Aug;24(3):593–614. doi: 10.1016/s0889-857x(05)70028-4. [DOI] [PubMed] [Google Scholar]
  31. Khan Muhammad Asim. Update on spondyloarthropathies. Ann Intern Med. 2002 Jun 18;136(12):896–907. doi: 10.7326/0003-4819-136-12-200206180-00011. [DOI] [PubMed] [Google Scholar]
  32. Lovell D. J., Giannini E. H., Reiff A., Cawkwell G. D., Silverman E. D., Nocton J. J., Stein L. D., Gedalia A., Ilowite N. T., Wallace C. A. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N Engl J Med. 2000 Mar 16;342(11):763–769. doi: 10.1056/NEJM200003163421103. [DOI] [PubMed] [Google Scholar]
  33. MacDonald T. T., Hutchings P., Choy M. Y., Murch S., Cooke A. Tumour necrosis factor-alpha and interferon-gamma production measured at the single cell level in normal and inflamed human intestine. Clin Exp Immunol. 1990 Aug;81(2):301–305. doi: 10.1111/j.1365-2249.1990.tb03334.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Maini R., St Clair E. W., Breedveld F., Furst D., Kalden J., Weisman M., Smolen J., Emery P., Harriman G., Feldmann M. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999 Dec 4;354(9194):1932–1939. doi: 10.1016/s0140-6736(99)05246-0. [DOI] [PubMed] [Google Scholar]
  35. Maksymowych Walter P., Jhangri Gian S., Fitzgerald Avril A., LeClercq Sharon, Chiu Peter, Yan Alex, Skeith Kenneth J., Aaron Stephen L., Homik Joanne, Davis Paul. A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum. 2002 Mar;46(3):766–773. doi: 10.1002/art.10139. [DOI] [PubMed] [Google Scholar]
  36. Mau W., Zeidler H., Mau R., Majewski A., Freyschmidt J., Stangel W., Deicher H. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol. 1988 Jul;15(7):1109–1114. [PubMed] [Google Scholar]
  37. Mau W., Zeidler H., Mau R., Majewski A., Freyschmidt J., Stangel W., Deicher H. Evaluation of early diagnostic criteria for ankylosing spondylitis in a 10 year follow-up. Z Rheumatol. 1990 Mar-Apr;49(2):82–87. [PubMed] [Google Scholar]
  38. Mease P. J., Goffe B. S., Metz J., VanderStoep A., Finck B., Burge D. J. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet. 2000 Jul 29;356(9227):385–390. doi: 10.1016/S0140-6736(00)02530-7. [DOI] [PubMed] [Google Scholar]
  39. Mielants H., Veys E. M., Cuvelier C., De Vos M. Course of gut inflammation in spondylarthropathies and therapeutic consequences. Baillieres Clin Rheumatol. 1996 Feb;10(1):147–164. doi: 10.1016/s0950-3579(96)80010-0. [DOI] [PubMed] [Google Scholar]
  40. Moreland L. W., Schiff M. H., Baumgartner S. W., Tindall E. A., Fleischmann R. M., Bulpitt K. J., Weaver A. L., Keystone E. C., Furst D. E., Mease P. J. Etanercept therapy in rheumatoid arthritis. A randomized, controlled trial. Ann Intern Med. 1999 Mar 16;130(6):478–486. doi: 10.7326/0003-4819-130-6-199903160-00004. [DOI] [PubMed] [Google Scholar]
  41. Murch S. H., Braegger C. P., Walker-Smith J. A., MacDonald T. T. Location of tumour necrosis factor alpha by immunohistochemistry in chronic inflammatory bowel disease. Gut. 1993 Dec;34(12):1705–1709. doi: 10.1136/gut.34.12.1705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Olivieri I., Salvarani C., Cantini F., Ciancio G., Padula A. Ankylosing spondylitis and undifferentiated spondyloarthropathies: a clinical review and description of a disease subset with older age at onset. Curr Opin Rheumatol. 2001 Jul;13(4):280–284. doi: 10.1097/00002281-200107000-00006. [DOI] [PubMed] [Google Scholar]
  43. Palferman T. G., Webley M. A comparative study of nabumetone and indomethacin in ankylosing spondylitis. Eur J Rheumatol Inflamm. 1991;11(2):23–29. [PubMed] [Google Scholar]
  44. Partsch G., Steiner G., Leeb B. F., Dunky A., Bröll H., Smolen J. S. Highly increased levels of tumor necrosis factor-alpha and other proinflammatory cytokines in psoriatic arthritis synovial fluid. J Rheumatol. 1997 Mar;24(3):518–523. [PubMed] [Google Scholar]
  45. Ritchlin C., Haas-Smith S. A., Hicks D., Cappuccio J., Osterland C. K., Looney R. J. Patterns of cytokine production in psoriatic synovium. J Rheumatol. 1998 Aug;25(8):1544–1552. [PubMed] [Google Scholar]
  46. Rudwaleit M., Siegert S., Yin Z., Eick J., Thiel A., Radbruch A., Sieper J., Braun J. Low T cell production of TNFalpha and IFNgamma in ankylosing spondylitis: its relation to HLA-B27 and influence of the TNF-308 gene polymorphism. Ann Rheum Dis. 2001 Jan;60(1):36–42. doi: 10.1136/ard.60.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Sampaio-Barros P. D., Costallat L. T., Bertolo M. B., Neto J. F., Samara A. M. Methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol. 2000;29(3):160–162. doi: 10.1080/030097400750002021. [DOI] [PubMed] [Google Scholar]
  48. Schwarzer A. C., Cohen M., Arnold M. H., Kelly D., McNaught P., Brooks P. M. Tenoxicam compared with diclofenac in patients with ankylosing spondylitis. Curr Med Res Opin. 1990;11(10):648–653. doi: 10.1185/03007999009112691. [DOI] [PubMed] [Google Scholar]
  49. Silverstein F. E., Faich G., Goldstein J. L., Simon L. S., Pincus T., Whelton A., Makuch R., Eisen G., Agrawal N. M., Stenson W. F. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA. 2000 Sep 13;284(10):1247–1255. doi: 10.1001/jama.284.10.1247. [DOI] [PubMed] [Google Scholar]
  50. Simon L. S., Weaver A. L., Graham D. Y., Kivitz A. J., Lipsky P. E., Hubbard R. C., Isakson P. C., Verburg K. M., Yu S. S., Zhao W. W. Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial. JAMA. 1999 Nov 24;282(20):1921–1928. doi: 10.1001/jama.282.20.1921. [DOI] [PubMed] [Google Scholar]
  51. Targan S. R., Hanauer S. B., van Deventer S. J., Mayer L., Present D. H., Braakman T., DeWoody K. L., Schaible T. F., Rutgeerts P. J. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group. N Engl J Med. 1997 Oct 9;337(15):1029–1035. doi: 10.1056/NEJM199710093371502. [DOI] [PubMed] [Google Scholar]
  52. Van Damme N., De Vos M., Baeten D., Demetter P., Mielants H., Verbruggen G., Cuvelier C., Veys E. M., De Keyser F. Flow cytometric analysis of gut mucosal lymphocytes supports an impaired Th1 cytokine profile in spondyloarthropathy. Ann Rheum Dis. 2001 May;60(5):495–499. doi: 10.1136/ard.60.5.495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Van Den Bosch Filip, Kruithof Elli, Baeten Dominique, Herssens Annemie, de Keyser Filip, Mielants Herman, Veys Eric M. Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum. 2002 Mar;46(3):755–765. doi: 10.1002/art.511. [DOI] [PubMed] [Google Scholar]
  54. Van Deventer S. J. Tumour necrosis factor and Crohn's disease. Gut. 1997 Apr;40(4):443–448. doi: 10.1136/gut.40.4.443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Ward Michael M. Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum. 2002 Jan;46(1):223–231. doi: 10.1002/1529-0131(200201)46:1<223::AID-ART498>3.0.CO;2-#. [DOI] [PubMed] [Google Scholar]
  56. Williamson L., Illingworth H., Smith D., Mowat A. Oral quinine in ankylosing spondylitis: a randomized placebo controlled double blind crossover trial. J Rheumatol. 2000 Aug;27(8):2054–2055. [PubMed] [Google Scholar]
  57. Zeidler H., Mau W., Khan M. A. Undifferentiated spondyloarthropathies. Rheum Dis Clin North Am. 1992 Feb;18(1):187–202. [PubMed] [Google Scholar]
  58. van der Heijde D., Bellamy N., Calin A., Dougados M., Khan M. A., van der Linden S. Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group. J Rheumatol. 1997 Nov;24(11):2225–2229. [PubMed] [Google Scholar]
  59. van der Heijde D., Calin A., Dougados M., Khan M. A., van der Linden S., Bellamy N. Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis. J Rheumatol. 1999 Apr;26(4):951–954. [PubMed] [Google Scholar]
  60. van der Linden S., Valkenburg H. A., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. doi: 10.1002/art.1780270401. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES