Ankylosing Spondylitis: Alternative Names, Key Characteristics, and Management

What is another name for ankylosing spondylitis?

While "Ankylosing Spondylitis" is the universally accepted and most accurate medical term today, it was historically known by other names, most notably Marie-Strümpell disease or Bechterew's disease, named after the physicians who contributed significantly to its early understanding.

The Primary Alternative Names

Historically, ankylosing spondylitis (AS) has been referred to by several eponyms, which are names derived from individuals. The two most prominent alternative names are:

• Marie-Strümpell disease: Named after the French neurologist Pierre Marie and the German neurologist Adolf von Strümpell, who independently described the condition in the late 19th century. Their work provided early clinical insights into the inflammatory arthritis affecting the spine.
• Bechterew's disease: Named after the Russian neuropathologist Vladimir Bekhterev, who also provided significant early descriptions of the disease, focusing on its neurological and spinal manifestations.

While these historical names occasionally appear in older literature or specific regional contexts, Ankylosing Spondylitis is the standard, preferred, and most accurate term used in modern medicine and scientific discourse. This shift reflects a move towards descriptive terminology that directly conveys the nature of the disease rather than solely crediting its discoverers.

Understanding Ankylosing Spondylitis (AS)

Ankylosing Spondylitis is a chronic, progressive inflammatory disease primarily affecting the axial skeleton—the spine and sacroiliac (SI) joints. It is classified as a type of spondyloarthritis, a group of inflammatory diseases that cause arthritis, most commonly in the spine.

Key characteristics of AS include:

• Inflammation: The hallmark of AS is chronic inflammation, particularly at the entheses (where tendons and ligaments attach to bone).
• Ankylosis: Over time, persistent inflammation can lead to new bone formation, causing vertebrae to fuse together. This process, known as ankylosis, can result in a rigid, inflexible spine, often referred to as a "bamboo spine" on X-rays.
• Genetic Predisposition: A strong genetic link exists, with over 90% of individuals with AS testing positive for the HLA-B27 gene. However, not everyone with HLA-B27 develops AS.
• Systemic Nature: While primarily affecting the spine, AS can also impact other joints (e.g., hips, shoulders), eyes (uveitis), bowels (inflammatory bowel disease), skin (psoriasis), and, less commonly, the heart and lungs.

Why Different Names Exist

The evolution of medical terminology often reflects the progression of scientific understanding. Early descriptions of diseases were frequently attributed to the physicians who first characterized them. As medical research advanced and the underlying pathology of conditions became clearer, there was a shift towards more descriptive, internationally recognized nomenclature.

• Eponyms vs. Descriptive Terms: Eponyms like Marie-Strümpell disease honor historical figures but do not inherently describe the condition. "Ankylosing Spondylitis," however, is highly descriptive:
  • Ankylosing: Refers to ankylosis, the fusion or stiffening of a joint.
  • Spondylitis: Refers to inflammation of the vertebrae (spinal bones).
• This transition to descriptive terminology aids in clarity, consistency, and a more direct understanding of the disease's primary features for healthcare professionals globally.

Key Characteristics and Impact on Movement

For fitness professionals and those interested in movement, understanding the impact of AS is crucial:

• Pain and Stiffness: The most common symptoms are chronic back pain and stiffness, particularly in the lower back and buttocks. These symptoms are typically worse in the morning or after periods of inactivity and improve with exercise.
• Postural Changes: As the disease progresses and fusion occurs, individuals may develop a forward stoop (kyphosis) of the upper back and a loss of lumbar lordosis, leading to a characteristic "question mark" posture.
• Reduced Mobility: The fusion of spinal segments significantly limits spinal flexibility, affecting activities of daily living and exercise capacity.
• Fatigue: Chronic inflammation often leads to significant fatigue, impacting energy levels and motivation for physical activity.

Exercise as a Cornerstone of Management

While there is no cure for AS, effective management strategies, including medication and lifestyle interventions, can help control symptoms and prevent disease progression. For fitness enthusiasts and professionals, it's critical to understand that exercise is not just beneficial but a cornerstone of AS management.

Benefits of Exercise for AS:

• Maintains Mobility: Regular range-of-motion exercises help preserve spinal and joint flexibility.
• Reduces Pain and Stiffness: Movement can alleviate discomfort and improve morning stiffness.
• Improves Posture: Strengthening exercises for core and postural muscles can counteract the tendency for kyphosis.
• Enhances Cardiovascular Health: Individuals with AS may have an increased risk of cardiovascular disease, making aerobic exercise particularly important.
• Boosts Mood and Energy: Combats fatigue and improves overall well-being.

Exercise Considerations:

• Focus on Mobility: Exercises that promote spinal extension and rotation (within pain-free limits) are crucial.
• Strengthening: Emphasize core stability, gluteal strength, and upper back extensors.
• Low-Impact Aerobics: Swimming, cycling, and walking are often preferred to minimize joint stress.
• Flexibility and Stretching: Gentle stretching, especially for hamstrings, hip flexors, and chest muscles, can help counteract postural changes.
• Individualization: Exercise programs must be tailored to the individual's current disease activity, pain levels, and degree of spinal fusion. High-impact activities or exercises that cause pain should be avoided.
• Professional Guidance: Working with a physical therapist or an exercise professional experienced with AS is highly recommended.

When to Consult a Healthcare Professional

Early diagnosis and intervention are critical for managing AS effectively and minimizing long-term complications. If you or someone you know experiences persistent back pain and stiffness, especially if it's worse in the morning, improves with exercise, and is accompanied by fatigue, it is essential to consult a physician. A rheumatologist is the specialist who diagnoses and manages AS. Fitness professionals should always encourage clients with suspected AS symptoms to seek medical evaluation before initiating any new exercise regimen.