Ankylosing spondylitis | Muscular-skeletal diseases | NCLEX-RN | Khan Academy

Ankylosing spondylitis | Muscular-skeletal diseases | NCLEX-RN | Khan Academy

– [Voiceover] We’re going
to refer to ankylosing spondylitis as AS. So you don’t have to keep
hearing me say this long thing. But if we go word by word just once, you’ll see that ankylosing means fusion. So it describes the spine
being fused together. Spondy, this first part of
the word, refers to the spine. and then -itis anywhere is inflammation. So this is an inflammation of the spine and at the sacroiliac joint, actually, and it leads to the fusion of the area. There’s some buzz words surrounding it. So one of them would be
that it is the poster child for a group of different diseases that are referred to collectively as the seronegative spondyloarthropathies. Spondylo-, so again, that’s the spine, and then arthro, which
refers to joints in general, and then pathologies or illnesses. So what this means is that they are rheumatoid factor negative. They do not have rheumatoid factor. But they also can appear
like rheumatic joint diseases because it’s systemic and it
involves the immune system. So speaking of the immune system, the other buzz word you need to know is HLA-B17. I’m sorry, I always say that. It’s B27. Again, it’s part of the immune system. It’s an antigen on the surface of the cell that can be recognized by T-cells, which can recruit things to attack it. So this is the autoimmune
component of the disease. This HLA-B27 association
actually exists for the seronegative
spondyloarthropathies in general, but here, in particular, for AS you should remember that connection. And then, just a little
background information on the group of people
that tend to get this. Remember, nothing is absolute, but if we’re looking for patterns, it’s going to be males
and relatively young ones, actually, really young ones, from 15 to 45 is going to be the mean
or the biggest group of people who get AS or that’s
when it’s diagnosed the most. So the name kind of tells us what symptoms are characteristic. We have this fusion of the spine. I drew it kind of like here, because it can be in
the middle of the back, more commonly in the middle
to lower back of the spine. So look at the curvature of this, this natural curvature of the spine. So this is a person looking
to the right at the screen. The head is over here. As you come down the back,
it kind of curves in here, and the pelvis is down here. This whole thing is
supposed to allow you to bend forward, bend backwards. If you look at the area
here, you should be able to actually bend forward more
than you can bend backwards. But the important part is that
with ankylosing spondylitis you don’t have that kind of free movement because you have fusion, and this is why one of the nicknames for the
symptom is a bamboo spine. Like a piece of bamboo, instead of a bendable stack of bones. Bamboo spine. So while bamboo spine is
what we think of immediately when we see AS, remember that it’s a systemic autoimmune disease, which means it affects, it
could potentially affect everywhere in the body. And this person might have fever, malaise, other nonjoint problems. When we’re talking about
joints, aside from the spine, it also tends to affect
the iliosacral spine. Iliosacral. I haven’t drawn the
pelvic bowl of bones here, but this is the joint that,
think of it how your leg, your thigh attaches to your body. So the pain and inflammation
can actually go down, following the spine, and
can shoot into the legs, and the iliosacral joint
itself can be affected as well. So the pain, I think of it
as this area for joint pain. If we want to talk about systemic effects, it has a pattern of
affecting two other places. One is eyes, particularly uveitis, and the other one is the aorta. So the aorta is the
big pipe, the big hoop. This is just the four
chambers of the heart, and this is the left
atrium, the left ventricle. This is not anatomic,
because technically the aorta comes kind of above the
heart, comes out this way, but just drawing our little cartoon here, just to show you the aorta is this pipe that comes off of the left ventricle, and it pumps blood to the whole body. This is where oxygenated blood, where we think of red
blood with oxygen in it, reaches the rest of the body. So if we have inflammation
in the aorta here, you’ll see at least two
cardiovascular problems. First in the eyes we have uveitis. You can have redness, inflammation. This uveitis is kind of near
the front chamber of the eyes. It can lead to redness, pain, discomfort. They can be afraid of light. They can see things floating
in front of their vision that’s not really there
or not physically there. So that’s uveitis, and it has an HLA-B27 association as well. And then in the aorta, like I said, this is where all the
blood goes to the body. So if we have inflammation, inflammation in the
walls of the aorta here, we can get what’s called an aneurysm. An aneurysm is kind of like
if you have a pipe here and you have some slack in the walls or some weakening in the
walls, kind of bulges out here and becomes a weak point in the pipe. This can happen in our blood
vessels all over the body, but if it happens here,
this where the heart and the aorta are connected
is the aortic valve. Very important valve
that prevents the blood from flowing this way, the
backflow into the heart. So if you have uveitis,
you might have a stretching or an aneurysm near the
opening here, near the valve. This part is just slack, and
the valve can’t close properly. And then what you get is some backflow into the chamber of the heart. And we use green to show backflow. So red, forward flow. Green is back. So not only is the body
not getting enough blood, but the heart has to pump extra volume because each time what’s
pumped out comes back in. So this can lead to a
serious problem in the heart, and we call it aortic regurgitation, meaning from the aortic
valve there’s backflow. Regurgitation. This is a side effect of the aortitis, but it’s also it’s own disease. Oh, I forgot to write
out aortitis, aortitis. If you realize the pattern here, -itis. Itis in spondylitis, everything
-itis means inflammation. Unfortunately, AS is very
difficult to diagnose. DX for diagnosis. Because the symptoms,
even though it looks like I’ve demonstrated a pattern here, it really can occur anywhere. It can just look like plain
old osteoarthritis for years. So it’s a tricky thing to diagnose, and there’s different ways to
go about it, different levels. So we can start with an x-ray. The bamboo spine, if it’s
already fused, we can see it. There might be blood tests,
because the blood will show us, there’s no AS blood
test, but it will show us how much inflammation is there. For example, the erythrocyte
or red blood cell sedimentation rate. This is a marker for inflammation. So is the C-reactive protein. So these are also nonspecific to AS, it could be any autoimmune disease, but at least it will help
us know we’re dealing with an autoimmune disease and
not just wear and tear. There’s also genetic, because
this disease seems to have a pretty genetic pattern. Also, the coding for HLA-B27,
the coding for the antigen, we can trace that as well. And then there’s something
I guess we don’t really use to diagnose AS, but we do use it to track how it’s progressing,
how fast and how bad, and it’s called the Bath, which is the place in England
where it’s discovered, Ankylosing Spondylitis Disease Activity Index. What a mouthful. Everything is an acronym. But this index allows us to again track how this patient is doing over time, how they’re doing with their treatment. And speaking of treatment, managing AS can seem, can
look actually a lot like managing rheumatoid arthritis
or the autoimmune diseases because the principle is the same. You need to reduce inflammation. There’s a class of different drugs that with different mechanisms but they’re grouped together
as disease-modifying anti-rheumatic drugs, because it used to be developed for rheumatoid arthritis. So what’s special about
them is even though they go about it in different directions, it actually slows the
progression of the disease, not just treat the symptoms. And we’re going to use
this for AS as well. There’s tumor necrosis factor, which is something that causes
inflammation in the body. It’s basically something
that can program a cell to kill itself, which can
be helpful in preventing cancer within our body, but here it’s just acts to the inflammation. So TNF inhibitors can be used, again to reduce the inflammation
going around in the body. We can use NSAIDs. These are the over-counter, you think of probably as pain meds, for example, your ibuprofen. And they not only treat the pain, because the fused spine and everything can be really painful, they
can also reduce inflammation. And then stronger pain meds as well, depending on the level of discomfort. So, as you see, the theme here
is to decrease inflammation. That’s the most basic ankylosing
spondylitis in a nutshell. Remember that it can be similar
to rheumatoid arthritis, in terms of affecting the whole body and a lot of inflammation. But the fact that it fuses
and affects the spine, the eyes, the heart, and the
fact that it does not have rheumatoid factor makes it different.


  • Jannick Achtergaele says:

    Is this also called Bechterew Disease?

  • Clair Williamson says:

    AS can also affect other joints. I have AS in all my joints. I'm also girl and diagnosed when I was 8 so I'm a little atypical. 😁

  • indeted075 says:

    I'm annoyed that certain experts keep saying that AS is a man's arthritis. It is not!

  • Amr Elewa says:

    where is example of x-ray

  • xerpatrex says:

    Correct me if I am wrong, but since when aorta comes from Left Ventricle?

  • Mostafa Bappi says:

    I just have watched about 1000+ videos based on AS. The age of raising AS is described as very confusingly. Here it shows 15-45yrs. Other videos said 17-30, 20-40 etc. Medical science is going down really. Funny

  • Nelly Hoffman says:

    Man i love khan academy 🙂

  • jyo m says:

    i m expecting more detailed

  • Practice says:

    this is such a slow description! Can't believe the heart is drawn back to front – this is NEVER how it is depicted!

  • Triyambakesh Mohanty says:


  • depj1000 says:

    I have severe cronic AS and even my neck is effected, I have 5 vertibre in my neck that is fused. I can hardly move my back and I suffer from lots of upper back pain, Neck pain and really bad headaches. I went undiognosed for a long time in my life, The pain started when I was 19 in my lower back but I thought that it was normal back pain and never really talked with a Dr about it. I am 38 and only dignosed it two years ago.

  • Mohammad Younus says:

    I have hla b27 positive with L4 L5-S1.

  • قناة ماهر maher channel says:

    Okay who wants some good news? I think I have managed to rid myself from ankylosing spondylitis and wanted to share my personal experience. Nearly 10 years a severe sufferer, and HLA-B27 positive. I have 2 words for you: Weight Lifting! Join a gym nowwww and do light/medium weight lifting. You won't be able to do anything in the beginning and it will hurt the following day like hell. It will hurt more and more as you go along, but keep at it, and take your normal pain killers while you continue working out. Work on your shoulders, back, buttocks, thighs.. keep lifting those weights. About 6-8 weeks later of daily weight lifting + stretches, come back and leave me a comment here. You can thank me later.

  • Paul French says:



    I keep thinking I have this but the doctor's say otherwise. the pain started in my pectoral minor, shifted to shoulder then elbow and my lower back always hurts when i bend in a certain direction. also on top of that my neck gets tight sometimes.

  • skate dd says:

    I have got ankylosing spondylitis. I've learnt how to manage it to the extent that I don't have any symptoms at all anymore only if I really clean and healthy lifestyle which includes no drinking alcohol no taking any drugs or smoking ever.. 90% of my diet is vegetables and fruits live glycemic carbohydrates very little grains only Greens I have a sunflower seed flax seeds chia.. maybe a little bread here and there..
    no dairy… maybe a couple of slices of cheese… I am 56 and got 10% body fat… about 40 days a week I run and… including martial arts 3 times a week…. I'm extremely healthy for my age… live a healthy lifestyle and you will have no problems… live an unhealthy lifestyle your life will be a mess…. which would you choose

  • skate dd says:

    yes you can use drugs but I would advise not to… Drugs Don't cure the symptom… the only cure the problem food's to avoid grains of all sorts brown rice is ok beer very bad for you corn very bad for you but is sensible and what you do

  • Papa Cleo says:

    I have this dreaded disease. I am seronegative and HLA-B27 negative.

  • hmmm mankind says:

    very helpful

  • Tiger93 says:


  • Karen Peterson says:

    OK I hear all about the "average" AS person! I am HLA-B27 negative female Dx at age 53! What is the research on the atypical patient such as myself?

  • Ines Rodrigues says:

    I loved this video, it helped me so much! Thank you!

  • Jonathan Coughlan says:

    every 1 look up the low starch diet ….a must .

  • Marten van den Poll says:

    HLA-B27 isn't always present with ASL patients

  • Gabitzu1100 says:

    I ve been diagnosed with ankylosing spondylitis at 18 years old male and it came like a shock for me . The gene HLA-B27 was positive
    Since i was a child, i was a spontanious person and i ve been practising a lot of sports. I was enjoying life and i loved my body. When i turned 15 years old, pains appeared in different spots of my body including: back, ankles, and especially knees, I thought its a normal thing wich occurs to normal people, but the pains didnt stop. There were getting worse and worse. Every morning i couldnt get out of my bed, i felt like my joints were fusing togheter. Im trying to have a healthy life based on fruits and vegetables and exercising. I cant stop this autoimune disease but im trying my best

  • Falalongkornz says:

    Who else is here from Zach's TryGuys vlog?

  • GuruLivesOn says:

    My mom has had AS since she's had it her whole adult life. I am aware that's it's hereditary do to the HLA-B27 antigen which makes me twice as likely to experience its symptoms. I'm 25 and according to my research, people are diagnosed with AS when entering adulthood (17-18). To this day, I've shown no signs of the disease. Does that mean I've been exempt or do I still have a chance to contract it later in life? Thanks for your answer. Cheers!

  • عمار الكريم says:

    انا من العراق مصاب بمرض التهاب الفقار الاصق ارجو المساعده ممكن اتواصل مع الدكتور وهذا رقمي الواتساب ٠٧٨١٦١٩٥٢٠٣

  • Eni Baraliu says:

    Actually AS starts on iliosacral joint and ascends to the lumbar portion of the spine not the other way around. 👍

  • Sugar Shine says:

    I disagree on the NSAIDs they cause a 50% rise in your chance at having a heart attack or heart failure in the first 7 Days of taking them the risk doesn't rise for long-term use but the point is they do cause a 50% rise in the chance of having some type of heart event so no on the NSAIDs I'm sorry I tend to disagree

  • nihal thapa says:

    why is Left v on the right side

  • Norman Rucker says:

    My mom has this. I think I do to. I had a chiropractor try to pop my back for several months and was unable to but finally got it to go. He told me I had fusions. this is before my mom was diagnosed. I feel like god awful shit all the time. No doctors want to help me because I am 27 and have fucked up teeth so I probably look like a drug addict or something. I just want to give the fuck up.

  • Testango says:

    spondilos stands for vertebra

  • Sally Ann Beck says:

    those SPOTS we see.. YES THEY ARE THERE what we are seeing is individual or an accumulation of cells that have bound together.. they are shed from the retinal walls .. fast treatment with predforte is important to avoid having these cells block the flow of ocular fluid and building up pressure in the eye. I have chronic re occurring Eyeritis and was diagnosed with it along with AS in 1988

  • Weal Ghadhban says:

    thanks alot for this informative vedio ,,,,but in 6.00 m you said if you have uveitis you might have an aneurysm!!!!



  • Saravanan palanimuthu says:

    Very clear and informative! Thanks

  • Doondi Phani Kumar says:

    no any brief matter

  • Li yichen says:

    amazing sound:)sounds so adorable~!

  • ali jaber says:

    I was enjoying watching the simple way of describing AS, until I was chocked by an unforgivable fault which is drawing the left part of the heart wrongly! How can I continue watching your videos when detecting such a mistake! I have no confidence in you from now, I'm sorry!

  • Asiago Bagel says:

    Thanks for this.

  • Thiên Thái says:

    Thank you, khanacademymedicine. You did an amazing video. I'm very appreciated when watching it, it helped me a lots, brought the orders so that I could understand and took it into my case. Thanks again!

  • Mike S says:

    I love that I have no idea what this person looks like. She doesn't have the "Hey! Look at me" disorder so many people have. Much more useful to look at cartoons than someone on their couch or in a gaming chair. So thank you.

  • AppLe CaT says:


  • Ajay Shah says:

    would prefer more discussion on pathophysiology of the disease. the crux of this video was spent on extra-articular manifestations, with little discussion about the enthesitis which actually leads to spinal manifestations

  • Rohit Raj says:

    I am a 20 year old student who just had just conquered his dream of pursuing bachelor in Computer Science from IIT and just after an year I started having pain in my hip and thigh joints and started living off with painkillers.When i consulted a physician he attributed this to my inactivity and later orthopedist thought that it is just a mild case of sacroiliitis. But after going through medication for 6 months I finally decided to consult a rheuomatologist. First i thought i had rheumatoid arthritis but then he suggested that I have Ankylosing Spondylitis and probably enthesitis. I develop some nodules on my elbow and i have constant pain and stiffness in my hips and thighs.
    My life has just turned upside down and i don't think anybody is able to understand my condition. I have been a quite cheerful guy but now i am not able to perform in any sphere of my life. Had to leave tennis and gym and studies is also getting affected from this.
    Depression has started to surround my life and I am just trying to fight it out. But my friends think that I am just making these things up as my performance has started to decline.Hope that someday i get out of this mess.
    Good luck to all those who are suffering from this.

  • Arka Mukherjee says:

    We don't want this types of lectures we want cures!!!

  • JOHANNES YU says:

    Okay so this is a posterior view of the heart…

  • keith lamont says:

    Red strain kratom really helps my pain red bali strain its a miracle

  • smitemeomightysmiter says:

    Not a good video. "bamboo spine" refers to how it appears in x-rays, not its stiffness

  • Ankylosing Spondylitis says:

    AS is a horrible disease. There is so many medicines , symptoms , doctors , depression , therapy and much more that is associated with AS. The best advice I can give some one that's looking for information on AS or u have AS and looking for more information is to speak to person with AS. Here is an example –

  • Lisa says:

    Got me when you drew the aorta in the wrong spot (should be on the top of the heart). Know it doesn’t really matter but it messes with my brain.

  • Camilia says:

    I have this disease and everything they're describing is my life!

  • Matt and Mariette O'Sullivan says:

    I have had AS for seven years, and severe crippling AS for three. The western medical response is to drug to mask the symptoms, but this is a short road to cascading side effects and death. I have now stopped ALL pharma meds, and in three months I have almost cured my disease through radical dietary change. Google Ankylosing Spondylitis diet cure, or Clint Paddison, or low starch AS cure.

  • Kerim Yildirim says:

    In my opinion, you are giving way to much irrelevant information

  • Dark Angel says:

    AS is a horrible disease. Your life just evolves around pain on a daily basses. Some people don't have it so bad, but for some it's disabling. AS is a gateway to more chronic diseases. To see some one living with AS , this is a very good channel to see a daily routines of a AS sufferer

  • REBEL says:

    I am very depressed. If you have AS, get ready.

  • samir suleymanov says:

    This disease can be easily treated. Without any drugs. Just 10 days fastining completely treats this disease. But after fasting need to be careful for having meal. There are procedure how to carry on after fasting. You can find from internet about fasting procedure.

Leave a Reply

Your email address will not be published. Required fields are marked *