Sciatica Pain Complications

Managing Complications for Spondylitis Patients

OK. So what I'm going to try to address for you today, this is just an outline. is what can be affected besides the joints in your body when it comes to spondylitis. And different from many diseases. In fact, this is true with regards to many rheumatologic diseases. These are systemic diseases. So they affect the whole body. Though the most common place they go is the joints or the spine or the sacroiliac joints. Other parts of the body can be affected.

I'll address what the long term complications are and why they occur in patients. And what you can do to help screen and prevent these complications. For the purpose of the talk I will use the term ankylosing spondylitis. We're going to sort of say this is analogous to spondyloarthritis. Although ankylosing spondylitis is a type of spondyloarthritis. Really, anyone within this entire family can have any of these manifestations or complications. So, if you just think about the organ systems that can be affected besides the joints. These are the three major ones: the eye, the skin and the gut, the gastrointestinal system.

We're going to go through each of these individually. So, first the eye and the reason I start with the eye is because. Eye inflammation is probably the most common nonjoint manifestation that can affect patients with ankylosing spondylitis. And this is in the form of something called uveitis or iritis, typically affecting the anterior chamber. So, this is an anatomy of an eye, and if you've had iritis before. Which many patients have, then you may not realize actually where the inflammation is. So my cursor is pointing to the anterior chamber. That's the chamber of fluid that is in front of the lens of the eye.

That is most commonly where inflammation happens in this disease. It's the most common nonjoint manifestation. Affecting somewhere between 25 to 40 percent of ankylosing spondylitis patients at some point in their disease course. And it could be the presenting manifestation, but it could also happen after the diagnosis of the arthritis. It's particularly more common in patients that are HLA B27 positive. So if you have AS and you're B27 negative, it is far less likely that you will develop this complication. The symptoms and signs to watch out for are usually one side of the eye is affected. The light is really bothersome to patients. We call this photophobia.

There is often pain when you change focus. So when you think about a camera changing the focus of a lens. When you look from far to near, that is quite painful. Patients can have red eyes as well. you can see on the left side, here is a patient with active iritis or uveitis. You can see the redness of the eye and then you can actually see a layer of white fluid that's collected at the bottom. That's pus, so those are white blood cells in the front part of the chamber of the eye. This is iritis or uveitis. So the treatment for this complication is actually quite simple as long as it's identified early. That is steroid drops in the eye.

Sometimes we will also use dilating drops to dilate the eye and that helps with the pain. Though, if it's not treated promptly and certainly if patients develop chronic uveitis. Then they may require either an injection of steroids to the eye or even oral or injectable medicines. If you've had uveitis before, multiple times, then you should actually have drops at home prescribed to you by your rheumatologist or your ophthalmologist. So that you can initiate prompt treatment of active iritis and then follow up immediately with an ophthalmologist. This is really important. We know that patients recognize when they have iritis, in fact, more so than a rheumatologist would. So if you're at home on a Saturday morning and you realize that your eye is flaring.

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