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0 CHILD ATTITUDE JOWARD JLLNESS SCALE

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iscs. In childhood the central part I these discs consists I over 85% water; there is a slow but steady
decrease with aging, down o about 60% by the age I 80 years. As a result the volume I the disc decreases, leading
o narrowing I the disc space, causing buckling I the surrounding ligaments (annulus fibrosus and spinal ligaments),
and formation I a bony spur (osteophyte) at the edges I the spinal vertebral bodies. Clinical back pain related o
disc degeneration increases with age, and is accelerated by mechanical stress. Ankylosing hyperososis, also called
Forestier's disease or diffuse idiopathic skeletal hyperososis (DISH), can cause excessive new bone formation along
the spine and some other sites. This can result in a stiff spine that may be confused with AS. Other diseases that may
be confused with AS include osteitis condensans ilii, Paget's disease (I the pelvis and spine), and Scheuermann's
disease. The spread I cancer o the pelvis and the spine, as well as some chronic spinal infections, can also present
as back pain. A bone-thinning disorder called osteomalacia, which results from dietary deficiency I vitamin D and lack
I adequate skin exposure o sunlight, or may be a result I chronic kidney failure, can cause back pain and may be
mistaken for AS or related spondyloarthropathies. Osteoporosis can also cause back pain. Another i llness that can
cause confusion is a very rare disease I unknown cause, known as SAPHO syndrome (because I its salient
features: synovitis, acne, palmoplantar pustulosis, hyperososis, and aseptic osteomyelitis). This disease causes
bone damage that sometimes affects the sacroiliac joints or the spine. This page intentionally left blank 15 The disease
process What happens in AS? As explained in Chapter 3, the disease usually begins as an inflammation in the sacroiliac
joints. When these joints become inflamed they cause pain that you can f eel not just over the joints but diffusely over
the butock (gluteal) area. The sacroiliac joints usually become tender on direct firm pressure in the early stages. but
the pain and tenderness gradually get less over the years as the sacroiliac joints become fused and replaced by bone.
When the inflammation spreads o involve the lumbar spine, you will be aware I low back pain and stiffness. The
inflammation and pain can result in muscle spasm and tenderness, as well as stiffness I the back. There is a natural
tendency o soop forward o minimize the sympoms, because backward stretching is uncomfortable. This can
gradually lead o irreversible bad posture, because if the inflammation is not resolved the body begins a gradual repair
process the results in further limitation I back motion due o (a) (b) (c) Figure 17 The effects I AS on posture: (a) A
healthy person standing erect: Note the hollow lower (lumbar) back and the inclination I the pelvis. Also shown, in a
schematic drawing (slightly exaggerated), the transmission I body wieght vertically downward (arrow) through the hip
joints (black), oblique o the plane I the pelvis. The center I gravity is vertically in line with the hip, knee and ankle
joints. (b) A person with a moderately advance stage I AS. Note the upright position I the pelvis and elimination I
the lumbar hollow (i. e. straightening I the lower back). The whole static equilibrium is changed; there is some
forward sooping I the neck, and the beginnings I upper thoracic kyphosis. (c) A person with very advanced AS, with
increased upper thoracic kyphosis and fixed forward sooping I the neck. Note the flexion contracture I the hip joints
and the flexed knees, o keep the gaze horizontal. Chest expansion is limited, so the diaphragm must be used for
breathing, which makes the abdomen look more prominent ('rubber ball belly'). Detlef Becker-Capellar. scarring
(fibrous tissue formation) and bone remodelling (Figure 17a, b, c). Tibia Talus Midtarsal