Question

Respected sir
I read your article about ankylosing spondylitis, and found it very informative.
At present I am living in riyadh. Saudi arabia.
My son, hassan abdul mubeen, age 17, complaint: shoulder pain only (not continuous, light or mild) for about one year (no back pain at all), was diagnosed (by two egyptian doctors, one rheumatologist specialist, second one rheumatologist consultant): ankylosing spondylitis.
Grateful, if you kindly see the following mri and x-ray reports of my son and advise:
(1)is this for sure ankylosing spondylitis?
(2)blood tests reports: normal some costly blood test reports are awaited (in 2 weeks).
(3)after these blood reports doctor will start biological medicine (most likely enbrel 50 mg). Is it safe at this stage and age.
(4)any other suggestions please (5)once I come to india, I will like to see you.
Abdul mubeen
1- mri study of pelvis and sacroiliac joints (05/10/2021):
findings:
•bilateral symmetrical narrowing of both sacroiliac joints with odema signal at the iliac and sacral sides of articulation. It is more involving the inferior joints portion and more at right side.
•normal mri signal of other scanned articular bones
•normal mri appearance of the scanned muscle groups
impression: findings are suggestive of bilateral symmetrical sacroiliitis,
2- x-ray exam study of pelvis and sacroiliac joints (05/10/2021)
-narrowing of proximal part of right sacro iliac joint
- normal appearance of left sacroiliac joint with intact articular surface and marinated joint space.
-normal bone, no fracture line
3- exam: torso-lumbar spine (05/10/2021)
-straightening of examined torso lumbar spine with tilt of dorsal spine to left side.
-normal osseous texture of the examined dorsal vertebrae.
-preserved disc spaces.
-no gross paraspinal soft tissue abnormalities could be noted
-intact both sacro iliac joints,
4- x-ray examination of the cervical spine in ap & lateral views- (31/08/2021): -straightening of the cervical spine.
-normal osseous texture of the examined cervical vertebrae.
-preserved disc spaces.
-no bony cervical ribs.

Dr.Julie Mercy J David · Accepted Answer

Ankylosing spondylitis is a cause of back pain in adolescents and young adults.
Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints
chronic inflammation in these areas causes pain and stiffness in and around the spine, including the neck, middle back, lower back, and buttocks. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis causes loss of mobility of the spine.
Pt treatment deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Are also advised to sleep on a firm mattress and avoid the use of a pillow in order to prevent spine curvature. Aerobic exercise is generally encouraged as it promotes full expansion of the breathing muscles and opens the airways of the lungs.
Home remidie
physical therapy for ankylosing spondylitis includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Since ankylosis of the spine tends to cause forward curvature (kyphosis), patients are instructed to maintain erect posture as much as possible and to perform back-extension exercises. Patients are also advised to sleep on a firm mattress and avoid the use of a pillow in order to prevent spine curvature. Ankylosing spondylitis can involve the areas where the ribs attach to the upper spine as well as the vertebral joints, thus limiting breathing capacity. Patients are instructed to maximally expand their chest frequently throughout each day to minimize this limitation.
Physical therapists customize exercise programs for each individual. Swimming often can be a very beneficial form of exercise, as it avoids jarring impact of the spine. Ankylosing spondylitis need not limit an individual's involvement in athletics. People can participate in carefully chosen aerobic sports when their disease is inactive. Aerobic exercise is generally encouraged as it promotes full expansion of the breathing muscles and opens the airways of the lungs.
Cigarette smoking is strongly discouraged in people with ankylosing spondylitis, as it can accelerate lung scarring and seriously aggravate breathing difficulties. Occasionally, those with severe lung disease related to ankylosing spondylitis may require oxygen supplementation and medications to improve breathing.
People with ankylosing spondylitis may need to modify their activities of daily living and adjust features of the workplace. For example, workers can adjust chairs and desks for proper postures. Drivers can use wide rearview mirrors and prism glasses to compensate for the limited motion in the spine.
You should check with your doctor before using compression socks for your swelling. These special socks should be properly fitted for you and your needs. Also, be sure to wear them during the day and remove them before you go to bed.
Leg elevation
if you stand a lot during the day, try propping your feet up or soaking them in water when you get home to help prevent swelling.
Muscle relaxant: reduces muscle tension and helps relieve muscle pain and discomfort. Transcutaneous electrical nerve stimulation (also known as tens) is something which helps ease muscle pain and spasms. You can strengthen the muscles by doing tonificationie. Improving the tone of the muscles by adding either weight cuffs / sand bags which will help you to improve the strength of the muscle.

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