Ankylosing spondylitis: recent breakthroughs in diagnosis and treatment.

Ankylosing spondylitis (AS) is generally easy to diagnose when the characteristic findings of the "bamboo" spine and fused sacroiliac joints are present on radiographs. Unfortunately, these changes are usually seen late in the disease after tremendous suffering has been incurred by the patient. Diagnostic delay averages seven to ten years. Historically, once the diagnosis was made, the treatment options were often inadequate or poorly tolerated in many individuals. This condition most often starts in early adulthood when people are typically in the earlier stages of their careers, resulting in diminished workforce participation and decreased quality of life. If an individual has a family physician, this might be the first encounter with a healthcare provider. Quite often, the initial practitioner is sought at a public walk-in clinic or chiropractic office. In recent years, there have been two major developments in the management of AS that make earlier diagnosis possible and offer the hope of alleviating pain and preventing structural changes that result in loss of function. These developments include the use of magnetic resonance imaging (MRI) to visualize the inflammatory changes in the sacroiliac joint and the axial spine, and the demonstration that tumor necrosis factor (TNF) blocking agents are highly efficacious in reducing spinal inflammation and possibly in slowing radiographic progression. This review outlines diagnostic strategies that can help identify AS in its earlier stages. Special attention is focused on treatment advances, including the use of anti-TNF agents, and how these medications have been incorporated into clinical recommendations for daily use.