Early treatment can rein in crippling disease-Ankylosing Spondalitis


ONLY one in five patients at the Singapore General Hospital (SGH) with the painful, chronic condition ankylosing spondylitis is a woman.

But the reason is not because women are less likely to get this disease, but because they are “severely under-diagnosed”.

Internationally, as many women as men suffer from the disease, which almost always starts when people are in their 20s and 30s.

SGH rheumatologist Lui Nai Lee said a possible explanation for the under-reporting in Singapore is that the condition has traditionally been associated with men.

There is no cure. But early identification is important as treatment can reduce both the immediate pain and the long-term consequences, such as going blind, suffering from heart problems or, more commonly, having a twisted or hunched back.

Ankylosing spondylitis is a form of chronic inflammatory arthritis that primarily affects the spine and the hips. Over years, the spine gets fused – often known as bamboo spine – severely restricting movement such as turning the head.

The main symptom is lower back pain – although only about one in 20 people with chronic lower back pain suffers from some form of spondyloarthritis, said Dr Lui.

In ankylosing spondylitis, the back pain is worse at night and does not improve with rest but does get better with exercise.

Professor Robert Landewe, a rheumatologist at the University of Amsterdam, said that if taking a non-steroidal anti-inflammatory drug (Nsaid) such as Synflex or Naproxen reduces the pain significantly, chances of it being ankylosing spondylitis are high, since the drugs reduce inflammation.

Other manifestations include the skina inflammation called psoriasis, inflammation of the eye, joint and hip pain, and occasional tightening of the chest wall.

Treatment for the majority of sufferers comprises high doses of Nsaid taken daily.

This reduces the inflammation, which is the main cause of pain and degeneration of the spine.

But for about 30 per cent of patients, this is not good enough. Their pain remains severe and the disease continues to progress.

For them, there are now biologic drugs that can help.

They can result in the partial remission of the disease in about one in four of these patients, and significant reduction in pain for the rest.

But the medicine is not cheap, costing $15,000 to $20,000 for a year’s supply. Patients will need it for the rest of their lives.

Dr Lui said patients who cannot afford the high cost can get subsidy from the Medication Assistance Fund.


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