Bright Sight

Oliver Backhouse, Consultant Eye Surgeon

Ankylosing Spondylisis

Ankylosing Spondylitis (AS) is different from Rheumatoid Arthritis but may be understood as arthritis of the spine. It is strongly relate to an HLA B27 genetic make-up (See separate HLA B27 and iritis information leaflet) which predisposes an individual to joint inflammation following some type of immune stimulus such as an infection. This genetic predisposition has a 50% chance of being passed on to future generations of both sexes but only approximately half of these will show evidence of the clinical disease.

AS affects about 1 man in 200 and 1 female in 500 and starts in the late teens or early twenties. Men are more severely affected but the degree that the disease shows itself varies enormously. The discomfort is usually in the lower spine. Many arthritis type conditions can also cause inflammation in the eye which is called Iritis / Uveitis. In AS patients who are HLA B27 positive, about 40% will have this type of eye inflammation. Occasionally it can also affect the heart and, later on, breathing as chest movements become restricted.

Recently a new group of drugs called anti-TNF therapy have been used in patients with AS and have produced some remarkable results. The most commonly used are Infliximab and Adalimunab. The excitement with this therapy is that they have the potential to truly modify the clinical outcome of the disease rather than just managing the discomfort. TNF (Tumour Necrosis Factor) should be thought of as one of the keystones in the immune reaction. Hence by switching off TNF the immune response, whose side effect produces the inflammation, is dramatically reduced. It will be necessary to repeat the anti-TNF injections at regular intervals according to the clinical response. They have been described as the greatest breakthrough in the treatment of AS since AS was first described 3,000 years ago. The decision to use this medication will be made by your Rheumatologist.