Name of the Condition

• Ankylosing Spondylitis of Multiple Sites in Spine, also known as Marie-Strümpell disease or Bechterew's disease.

Summary

• Ankylosing spondylitis is a type of chronic, inflammatory arthritis that primarily affects the spine, leading to pain and stiffness from the neck down to the lower back. In severe cases, the inflammation can result in new bone formation on the spine, causing sections to fuse in a fixed, immobile position, significantly impairing mobility and posture.

Causes

• The exact cause is unknown, but genetics play a significant role. The presence of the HLA-B27 gene is strongly associated with the development of ankylosing spondylitis.

Risk Factors

• A family history of ankylosing spondylitis.
• Being male; the condition affects men more frequently than women.
• Being between the ages of 15 and 45.
• Presence of the HLA-B27 genetic marker.

Symptoms

• Persistent back pain and stiffness, particularly severe in the morning or after periods of inactivity.
• Pain in the buttocks and lower back that improves with activity and worsens with rest.
• Decreased flexibility of the spine over time.
• Fatigue and weight loss are possible systemic symptoms.

Diagnosis

• Physical examination and assessment of medical history.
• Imaging tests like X-rays or MRI to detect changes in the spine and joints.
• Blood tests to check for the HLA-B27 antigen and inflammatory markers.

Treatment Options

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain.
• Disease-modifying antirheumatic drugs (DMARDs) or biologics for severe cases to slow progression.
• Physical therapy to improve posture, flexibility, and strength.
• Surgery is rarely needed but may address severe joint damage.

Prognosis and Follow-Up

• The condition is chronic with no current cure but can be effectively managed with treatment.
• Regular follow-ups are essential to monitor disease progression and adjust treatment plans.
• With early and appropriate treatment, many individuals maintain functional mobility.

Complications

• Severe spinal deformity like kyphosis.
• Eye inflammation (uveitis).
• Reduced lung function due to chest wall restriction.
• Cardiovascular issues, such as heart valve problems.

Lifestyle & Prevention

• Regular exercise to maintain spinal flexibility and overall fitness.
• Good posture techniques and practices to help prevent complications.
• Smoking cessation and weight management to reduce strain on the body.

When to Seek Professional Help

• Persistent stiffness and pain in the lower back or buttocks.
• Experiencing joint pain or swelling unrelated to a specific injury.
• Sudden loss of flexibility or onset of back pain with fever.

Additional Resources

• Spondylitis Association of America: spondylitis.org
• Arthritis Foundation: arthritis.org

Tips for Medical Coders

• Ensure accurate documentation of all affected spine regions.
• Confirm the presence of symptoms specific to ankylosing spondylitis for precise coding.
• Be mindful of distinguishing this condition from other types of spondyloarthritis.