On May 4, 1951, Robert Alan Deal was born to Tina and Frank Deal.  The transformation into the guitar legend known as Mick Mars started at age six with a Mickey Mouse guitar and ended with an advertisement.  After dropping out of high school and living in his parents shed, Mick bounced from his first band “The Jades,” a Beatles cover band where he first played bass, then guitar to his next band, “White Horse,” to the global phenomenon known as “Motley Crue”. 

In April, 1981, Mick placed an ad in “The Recycler,” an LA newspaper.  He described himself as a “loud, rude, and aggressive guitar player.”  Bassist Nikki Sixx found the ad, and the rest, as they say, is history.  Sixx and Mars teamed up with Vince Neil, who was in a band called “Rock Candy” at the time, and his friend, Tommy Lee, to form a band that quickly became a force to be reckoned with. 

Mick is responsible for the killer guitar riffs in Motley’s music as well as some of the lyrics.  His guitar style is heavily influenced by the blues, as is evidenced by the numerous songs in which he uses a metal slide.  Mick tunes his guitar mainly in “drop D” to give Motley’s music its signature strong, crunchy sound, which also allows him to use more bends in his playing.  Motley Crue is such a huge success that they are still touring 28 years after they formed.  Their most recent tours include “The Carnival of Sins” tour in 2005, “The Route of All Evil” tour in 2006, and Cruefest, which has become a staple in the rock world, beginning in 2007 and still rocking through 2009.

It’s not all fun and games in the life of this rock star, though.  In 2001, Mick filed bankruptcy and battled with depression.  In 2004, he had a hip replaced.  Mick Mars has a medical condition that can be treated to an extent, but not cured.  His condition was fatal in prior centuries.  Mick Mars was diagnosed at age 19 with Ankylosing Spondylitis.  Over the course of his lifetime it has cost him a hip, three inches of his height, and all lower spinal movement.  But, he’s still a rock star.  He is still living his dreams.  If only we were all so driven.

The term Ankylosing Spondylitis (pronounced Ank-kih-low-sing Spon-dill-eye-tiss) comes from the Greek “Ankylosing” meaning “fusion” or “stiffening” and “Spondylitis” meaning “inflammation of the spine or spinal joints”.  It is a combination of an inflammatory disease related to chronic arthritis originating in and primarily affecting the spine and an auto immune disease, meaning that the body attacks its own cells.

“Ankylosis” is defined by the American Medical Association as “Immobility and consolidation of a joint or joints caused by disease or injury.  Ankylosis refers to the condition in which bones and other components of a joint are stiff or fixated, causing severe or complete loss of the joint’s movement.  It is also the term for a surgical procedure known as cervical spine fusion, which is performed to stabilize a joint, commonly in the neck or back.”  In the case of Ankylosing Spondylitis, the former definition is used.

Ankylosing Spondylitis has been known by many names, such as Marie-Strumpell Disease, Bekhterev-Strumpell Syndrome, Rheumatoid Spondylitis, and Spondylo-arthritis.  It is the primary disease in a related group of disorders known as “Sero-negative Spondyloarthropathies.”  This family of diseases includes Psoriatic Arthritis, Infectious Arthritis, Osteo Arthritis, and Reiter Syndrome.  All of these conditions are forms of arthritis affecting the spine; however they lack the “Rheumatoid Factor”.  Rheumatoid factor is defined as “Antibodies present in the majority of individuals with rheumatoid arthritis.  A diagnostic marker for Rheumatoid arthritis that is absent from Ankylosing Spondylitis and other sero-negative spondyloarthropathies.”   The relation of the disease to Rheumatoid Arthritis, a chronic autoimmune disease that is marked by inflammation of the membranes surrounding the joints, is heavily debated.  Some sources say that there is no connection at all between the two, due to the absence of the “Rheumatoid Factor” in Andylosing Spondylitis.  Other sources suggest that Anklylosing Spondylitis is a form of Rheumatoid Arthritis, while other sources suggest that Rheumatoid Arthritis may have evolved from Ankylosing Spondylitis.

Ankylosing Spondylitis targets the joint capsules, ligaments, or tendons that attach to the bone.  The resultant inflammation, which is a reaction of tissues to disease or injury, is often associated with pain and swelling.  This tenderness or pain is known as enthesitis, which causes the majority of the pain and stiffness associated with Ankylosing Spondylitis.

Ankylosing Spondylitis has been traced as far back as 4000 year old Egyptian mummies.  So far, there have been 18 recorded cases in Egypt between 2900 B.C. and 200 A.D.  There is also evidence of the disease in Neolithic France and Sweden, Pre-Roman Germany, Greece, and other parts of Europe.  Because of the complexities in diagnosis, it is possible that many more cases may have existed, but been misdiagnosed.

Twenty percent of all cases involve peripheral joints, such as shoulders, hips, pelvis, neck, and/or knees.  Fifty percent of patients have or develop arthritis in their hips.  This is more common in younger people, and also represents a more serious prognosis.  Hip pain can be direct or referred.  Referred pain means that the pain does not appear in the hips, but rather in the groin, knee, or thigh area.  One-third of patients reports shoulder involvement as well as hip involvement, although shoulder involvement is usually mild. 

The chest and lungs may also become involved in more advanced cases.  Chest involvements may include limited mobility or limited chest expansion, scarring, and fibrosis of the lungs.  Pain may be present when breathing deeply, similar to that of cardiac angina or pleurisy, if the outer lining of the lungs becomes inflamed.  Patients experiencing this should seek medical attention immediately to rule out more serious conditions.  For this reason, routine chest x-rays should be performed every five years, or more often as a doctor prescribes.  Smoking is strictly contraindicated in all cases of Ankylosing Spondylitis. 

In 33% of cases, the rib joints connecting the ribs to the spine and sternum, known as costro-vertebral joints, may become fused due to repeated inflammation and scarring.  This is known as fixed ribcage and it reduces chest expansion as well as respiratory capacity.  This creates functional lung impairment, which means that it will take longer to recover from colds or upper respiratory infections.  Deep breathing exercises are recommended to maintain and/or regain chest expansion.  It may be easier to accomplish these exercises after a hot shower or bath.  If these exercises are not possible, ice packs may be used periodically, in conjunction with neck and shoulder massage.  Physical therapists may also teach patients “Diaphragm Breaking,” which is a breathing technique that involves learning to manipulate and control the diaphragm in order to maximize air intake. 

Between two and ten percent of patients will have heart complications.  This can include arrhythmias, heart block, aortic insufficiency, inflammation of the aorta, and aortic valve disease.  Prolonged and untreated inflammation of the aorta can lead to valve leaks and or heart block, which may require surgery.  Aortic insufficiency is more common after long standing disease. 

Also commonly affected are the eyes.  33% – 40% of patients will experience Uveitis, which is “inflammation of all or part of the uvea, which consists of the middle vascular portion of the eye including the iris, ciliary body, and choroid, the lining inside the eye behind the cornea.”  The condition is easily treated, and usually does not permanently affect sight.  Symptoms include redness, pain, sensitivity to light and skewed vision.  Popular treatments include corticosteroid eye drops and dilating agent eye drops, such as cycloplegics.  Cycloplegics are corticosteroid eye drops used to paralyze the ciliary muscle in the eye, and can be used to treat Uveitis as well as Anterior Uveitis.  Between 5% and 35% of patients that develop Uveitis may develop Anterior Uveitis, which is a more severe form of inflammation that does not respond well to treatment and may cause vision to be affected permanently.  33% of patients experience Iritis, inflammation of the iris. 

Rarely, patients will experience neurological symptoms, known as Cauda Equina Syndrome.  The Cauda Equina is the terminal portion of the spinal cord and the roots of the spinal nerves which is located below the first lumbar.  Cauda Equina Syndrome is caused by scarring of these nerves over time due to the repeated inflammation associated with Ankylosing Spondylitis.  This can lead to urinary retention or incontinence (33% of Ankylosing Spondylitis patients with Cauda Equina Syndrome experience this), loss of bowel control, sexual dysfunction, and pain and/or weakness in the legs.  If the Cauda Equina is merely compressed, and not scarred, then patients will experience an absence of ankle jerks.  This is reported by 33% of Ankylosing Spondylitis.   

Rarely, patients may develop Amylodosis (Kidney failure), due primarily to the use of NSAIDs and other medications used to treat Ankylosing Spondylitis.  In cases that involve the brain, kidneys, lungs, or heart, life expectancy may be shortened.

The fatigue associated with Ankylosing Spondylitis is severe.  Patients describe it as wanting to be invisible, as “an overwhelming feeling of failure,” as “wearing an x-ray vest constantly,” or as “trying to wade through a pool of molasses with forty pound weights in ones pockets and suction cups attached to ones shoes.”  It is caused by lack of sleep, the body’s use of energy to fight inflammation, and by cytokines.  Cytokines are small proteins that are released by cells and have a specific effect on the interactions between cells and the behavior of the cells.  They include interleukins (these cells are involved in the communication of other cells involved in the inflammation process), lymphokines (these are related to and released by the lymphatic system, defends against pathogens and provides the body’s immune system), and cell signal molecules, such as tumor necrosis factor and interferons (both of these types of cells trigger inflammation and respond to infections).  They are released during the inflammation process and can cause symptoms ranging from fatigue to moderate anemia.

Diagnosis of Ankylosing Spondylitis has an 87% specificity (the proportion of people without a disease who are correctly classified as not having the disease), as well as an 87% sensitivity (the proportion of people with a disease who are correctly diagnosed).  Modern diagnosis leaves only thirteen percent of cases incorrectly classified, and another thirteen percent that will not be identified. 

The exact cause of Ankylosing Spondylitis is unknown for certain.  It is speculated that one possible cause could be genetics combining with environmental factors and other risk factors.  Those born with the genetic marker “HLA-B27” are especially susceptible to the disease.  It is speculated that there may be other genes that play a role in increasing risk.  People who have frequent infections of the intestines, genitals, or urinary tract have a higher possibility of developing the disease.  It is suggested that a person born with a genetic predisposition such as HLA-B27, who also gets frequent intestinal infections may have a breakdown in his or her intestinal defenses, allowing the bacteria or virus of the infection pass directly into the bloodstream and/or sacroiliac joint area.  The sacroiliac joint is the joint between the triangular bone below the spine (sacrum) and the hip bone (ileum). 

Between .25 – 1.5% of the world’s population is affected by Ankylosing Spondylitis.  That comes out to approximately 24,300,000 people world-wide, at least half a million of whom reside in the United States.  It affects more people than Multiple Sclerosis, Cystic Fibrosis, and Lou Gehrig’s Disease combined, and is the third most common form of chronic arthritis in the United States.  For every female affected by Ankylosing Spondylitis, two to three men are affected.  However, females tend to be diagnosed later, due to the fact that they tend to experience milder symptoms.  Age is also a factor, although sources opinions vary on the exact numbers.  Some sources claim that Ankylosing Spondylitis usually begins between age 20 and 40.  Others suggest ages 16 to 35.  Still others claim that it is most common in males over the age of 30.  If diagnosis is made before age 17, it is considered Juvinile Ankylosing Spondylitis.  It is also more common in people of Caucasian descent than those of African American descent, although the exact percentages are highly debated.  Some sources claim a 2:1 ratio while others claim a 3:1 ratio.  Less than one percent of the population is affected by this disease, but of those that are, 20% of them also has a relative who also has the disease.

The course and severity of the disease vary from patient to patient.  It can range from minor aches and pains to stooping of the back and bone fusion.  Typically, symptoms start in the lower back and hip region.  They may progress to shoulders, knees, neck, elbows, and other organs and joints.  Typically the disease worsens for about ten years then plateaus.  During the course of the disease, most (but not all) patients experience “flares” which are acute and painful episodes of the disease in its active state that are followed by temporary periods of remission. 

Bone fusion is the cause of the limited mobility associated with Ankylosing Spondylitis.  The bones first become inflamed and fragile due to the body’s autoimmune response, then fiber tissue forms in a process known as fibrosis.  This causes new bone formation which increases the risk of spinal fracture due to the inherent weakness of bone formed during this process.  Severe muscle spasms of the spinal muscles and ligaments can cause a forward flexing of the back.  If this is combined with fusion of the spine, it becomes known as “bamboo spine” or “kyphosis”.  The final result of the disease can be extreme rigidity, deformity, and a fusion of the bones involved.  In some advanced cases, patients may develop osteoporosis, a loss of bone density that can also increase the risk of fractures.

Most commonly, a Rheumatologist, a doctor that specializes in joints, muscles, tendons, ligaments, connective tissues, and bones, will be the person to diagnosis and treat a patient with Ankylosing Spondylitis.  The process of determining the diagnosis may include X-Rays, MRIs, a physical exam, patient and family medical history, and blood work.  A second doctor that may be involved in treatment of advanced cases is an orthopedic surgeon, a doctor specializing in surgically correcting joint and bone disorders.

In the early 1990’s the European Spondyloarthropathy Study Group developed a list of diagnostic criteria.  First, the patient must have spinal pain.  Second, the patient must have inflammation of the spine and surrounding joints which is asymmetric or primarily involving the lower extremeties.  The patient must also have one or more of the following:  a family history of Ankylosing Spondylitis, Sacroilitis (inflammation of the sacroiliac joint), acute diarrhea within one month before the onset of spinal symptoms, inflammatory bowel disease (this is a generalized term for any of several chronic inflammatory diseases of the gastrointestinal tract, including Ulcerative Colitis, Chron’s disease, Ileitis, Colitis, and/or Enteritis), Psoriasis (a common but chronic and unsightly skin disease), Urethritis (inflammation of the urethra), cervicitis (inflammation of the cervix), Iritis (inflammation of the iris), Uveitis (this is a non specific term for any intraocular inflammatory disorder affecting the iris, ciliary body, choroid, retina, or cornea), alternating buttock pain, and/or enthesopathy (a disorder of the ligament attachment to the bone).  For this reason, obtaining an accurate patient history is vitally important in diagnosis.

Diagnosis also includes a clinical evaluation.  This includes spinal and/or pelvic X-Rays, Magnetic Resonance Imaging (MRI), or other imaging techniques to determine the presence of inflammation of the sacroiliac joint, also known as sacroilitis, apophyseal fusion (bone fusion of the spine due to fibrosis), and other joint and/or tissue inflammation.  Magnetic Resonance Imaging is a technique that employs magnetic fields and radio waves to create detailed images of internal body structures and organs, however they are more costly to perform than X-Rays and there is not yet a standard method for evaluating the results.  However, X-Rays may take 7-10 years to show erosion of the spine or other involved joints. 

To be diagnosed with Ankylosing Spondylitis, the patient must be under age 35 at the start of symptoms.  There must be involvement of the sacroiliac joint, the joint at the base of the spine where the spine meets the pelvis.  The pain and stiffness in the lower back region must be ongoing over a period greater than three months and must also be progressive, worsening with time as well as periods of immobility, to be eased by exercise.   Sites of inflammation may include the back, pelvic bones, sacroiliac joints, chest, and heels, and inflammation and/or pain must respond positively to NSAIDs (non-steroidal anti-inflammatory drugs). 

Blood tests should also be performed.  One possible test is for the presence of HLA-B27, an antigen or protein marker on cells that may indicate the possibility of Ankylosing Spondylitis.  HLA or Human Leukocyte Antigen testing is a very simple and common procedure involving the white blood cells.  It is the same typing that is used to determine tissue compatibility in the organ transplant process or in DNA or paternity testing.  A second probable test is an ESR, or Erythrocyte Sedimentation Rate, test.  This test is indicative of inflammation.  More than 70% of patients diagnosed with Ankylosing Spondylitis show an elevated ESR.

Human Leukocyte Antigens are proteins responsible for helping the immune system to distinguish “self” from “non-self”.  HLA-B27 is an antigen which is located on the short arm of chromosome six.  It is a “tissue-type” marker on the surfaces of cells.  It is strongly associated with Ankylosing Spondylitis, representing 40% of overall risk.  Eight to nine percent of the human population has this gene and two to fifteen percent of those that have the gene will develop Ankylosing Spondylitis, based on other genetic predispositions, environmental exposure, or a possible variation of HLA-B27, as there are nine different subtypes.  It is important to note that not all patients diagnosed with Ankylosing Spondylitis will test positive for the HLA-B27 antigen - as many as five percent of patients diagnosed with the disease do not carry it.  In families with multiple members affected by Ankylosing Spondylitis, HLA-B27 is responsible for as many as 50% of the cases in the family.  There is speculation that a second gene, HLA-B60 may also be associated with the disease, although the association is much weaker.

Ancestry plays a role in a person’s probability of being born with the B27 antigen.  Native North Americans, Alaskan Eskimos, and Norwegian Lapps are high-risk ethnicities, while people of African ancestry, Australian Aborigenes, and Native South Americans are low-risk ethnicities.  Eight percent of the Caucasian population is born with HLA-B27.  90% - 95% of Caucasian Ankylosing Spondylitis patients test positive for HLA-B27.  80% of Mediterranean Ankylosing Spondylitis patients test positive for HLA-B27, while just 50% of African American Ankylosing Spondylitis patients test positive for the antigen.

The most common symptoms are chronic inflammation which causes progressive pain and stiffness, usually starting in the lower back.  The pain and stiffness may expand to include the rest of the back, the neck, and chest, as well as peripheral joints such as the shoulders, hips, knees, ankles, and feet.  The stiffness is especially intense in the morning, or after periods of inactivity.  It can usually be alleviated by a warm shower or gentle exercise.  Over time, the stiffness will become more widespread and severe.  Other organs, such as eyes, heart, lungs, skin, and gastro-intestinal tract may also be affected.  Low grade fever, weight loss and fatigue are also common symptoms.

Treatment of Ankylosing Spondylitis is multi-faceted.  Exercise, physical and/or occupational therapy, massage, good posture practices, the use of heat and cold, diet and weight management, medicine, back braces, surgery, and electrical stimulators for pain, also known as TNS units, are all possible aspects of treatment.  Associated complications of the disease should be treated accordingly.

Sleeping on the back on a firm mattress with a thin pillow or no pillow at all is recommended for the purpose of minimizing curvature of the spine.  In some cases, back braces may be used to prevent or reverse deformity of the ribs and spine.

Exercise, such as swimming, is important to strengthen muscle groups to counter potential deformity, improve posture, prevent breathing problems, manage pain, and maintain range of motion as well as flexibility. 

Massage therapy and physical therapy are suggested to decrease pain, increase circulation, range of motion, flexibility, and to improve posture and lymph flow.  Physical therapists may also teach patients new ways to move to maximize effectiveness and minimize fatigue.

Using heat on stiff joints and tight muscles helps to reduce pain.  Using cold on areas of inflammation reduces swelling.

NSAIDs or Non –Sterodial Anti-Inflammatory Drugs are the first stage of medicinal treatment.  They can be over the counter or prescription strength, and there are several varieties available.  NSAIDs are used to relieve symptoms associated with arthritis, gout, bursitis, tendinitis, sprains, strains, injuries, and menstrual cramps, in addition to its suggested use in association to Ankylosing Spondylitis.  Some brands also offer fever reducing properties.  NSAIDs work by blocking the formation of prostaglandins, substances produced by the body that can cause pain and inflammation.  It may take time to find the right drugs and doses for each individual due to differing reactions to medicines.  Further, it may take several weeks to see improvement in symptoms, and it is important to continue to take medicine as prescribed and on time. 

Commonly used NSAIDs include Ibuprofen (the active ingredient in such brands as Advil and Motrin), Naproxen (Naprosyn, which is the active ingredient in Aleve, but also comes in prescription strength formulas), Indocin (Indomethacin), Celebrex (Celecoxib), Arthrotec (Diclofenac & Misoprostol), Mobic (Meloxicam), and Voltaren (Diclofenac).  

Caution should be exercised while taking these drugs, as they can be potentially damaging to the gastrointestinal tract.  Possible side effects of NSAID treatment are upset stomach, gastric ulcers, bruising, high blood pressure, water retention, drowsiness, headache, dizziness, confusion, heart burn, and stomach inflammation, such as gastritis (an irritation of the stomach lining which is usually a precursor to an ulcer) or ulcers (sores on the stomach lining usually accompanied by disintegration of the tissue and sometimes pus). Patients with ulcers and duodenal ulcers (an ulcer on the first part of the small intestine) should not take NSAIDs.  Stomach irritation occurs due to a reduction in the mucus in the stomach.  Gastrointestinal side effects caused by NSAIDs can be reduced or avoided by the use of other medicines, such as Cytotec and/or Carafate.  Cytotec is a medicine that can replace lost mucus, while Carafate is a medicine that can coat the stomach to help avoid the loss of mucus. 

A new class of NSAIDs known as COX-2 inhibitors or COXIBs reduce the possibility of gastrointestinal side effects.  COXIBs are anti-inflammatory agents.  Examples of these drugs include Vioxx (Rofeocoxib), Bextra, Celebrex, Arcoxia.  Vioxx and Bextra have been pulled from the market due to more serious side effects, such as heart attack.  Patients with a past or current risk of heart disease, heart attack, heart failure or strokes, or patients who are diabetic should exercise caution while taking these medications.

In cases when NSAIDs are ineffective, one temporary option is corticosteroid drugs.  These should be used only in severe cases and only for a limited time, due to the potential for long-term side effects.  One example is prednisone, which is an injection into the inflamed joint or joints.  Two common disorders of the feet associated with Ankylosing Spondylitis are Achilles Tendonitis and Plantar Fasciitis. Corticosteroid drugs are rarely used in the case of Achilles tendonitis due to the possibility of rupturing the tendon.  Their effectiveness in treating plantar fasciitis is not clear.

In the case that NSAIDs are ineffective, the second line of medications are known as disease modifying anti-rheumatic drugs.  Examples of these medications are Sulfasalazine, Methotrexate, Corticosteroids, and Biologics, also known as TNF-a blockers or inhibitors. 

Sulfasalazine, also known as Azulfidine, is prescribed to control pain and swelling in small joints, and also controls intestinal lesions associated with inflammatory bowel disease.  It is taken orally, in tablet form, and side effects are rare.  They include bloating, nausea, oral ulcers, and vary rarely bone marrow suppression.  This drug is usually only used in more severe cases.

Methotrexate, also known as Rhematrex, is used to treat everything from Cancer to Rheumatoid Arthritis.  When it is used to treat Ankylosing Spondylitis, a much smaller dose is used.  It comes in two forms, either as a self-administered shot, or in a tablet form.  It is recommended that it be taken in conjunction with folic acid to suppress side effects.  The most common side effects are oral ulcers and nausea, and these can be minimized with the addition of folic acid supplements.  Frequent blood counts and liver tests should be done to reduce the risk of more serious side effects.  This drug is usually only used in more severe cases. 

TNF-a is an acronym that stands for Tumor-Necrosis-Factor alpha.  Examples of TNF-a blockers are Enbrel (Enanercept), Remicade (Inflixmab), and Humira (Adalimumab).  Biologics may slow or in some cases even halt the progression of Ankylosing Spondylitis.  They treat joints as well as spinal arthritis.  Enbrel and Humira are examples of recombinant human soluble tumor necrosis factor alpha agents.  They reduce the auto-immune responses that cause inflammation.  TNF-a inhibitors are administered intravenously in several ways.  Enbrel is self administered injection that is administered once or twice a week.  Humira is also self administered, but it is administered once every other week.  Remicade is administered via an IV in the doctor’s office every six to eight weeks.  Remicade, also known as Infliximab, is made from human and mouse components.  It is a chimeric monoclonal antibody that works by interfering with the body’s inflammatory response.  Side effects associated with TNF inhibitors are increased infections, such as tuberculosis, and increased cancer frequency, especially leukemia, or cancer of the blood, and lymphoma, or cancer of the lymphatic system (the immune system).

In severe cases, surgery may be necessary to replace destroyed joints or to straighten or re-align the spine.  The goal of these surgeries is to improve joint function and minimize pain.

Naturopathic healers suspect that food allergies may combine with abnormal bowel function to cause increased circulation of antigens to the body. Following this theory, the body would then respond by producing anti-body antigen complexes similar to those present in Rheumatoid Arthritis patients. There is no known prevention, and there is no cure.

Naturopathic healers suggest that diet may be an integral cause of Ankylosing Spondylits as well as a possible treatment for the disease. Several possible problem foods include wheat, corn, dairy, beef, tomatoes, potatoes, and peppers. It is suggested that by removing these foods from one’s diet, and by maintaining a diet that is high in fiber and low in sugar, carbohydrates, meat, and animal fat, it is possible to relieve pain and reduce swelling associated with Ankylosing Spondylitis. Tobacco use is strictly contraindicated by these professionals as well. Accupuncture and massage therapy are also suggested to be of assistance.

Supplements including fatty acids and antioxidants are a suggested addition to the suggested diet. White Willow (Salix Alba), Yarrow (Achillea Milleforlium), Lobelia (Lobelia Inflata), Bryonia, and Rhus Toxicodendron are several suggested supplements in the treatment and maintenance of Ankylosing Spondylitis.

The most highly recommended resource for those diagnosed with Ankylosing Spondylitis is a book entitled, “Straight Talk on Spondylitis.” It is internationally recognized as the most comprehensive resource available to help people understand and manage Sero-negative Spondyloarthropathies.

• National Organization for Rare Disorders (NORD)
• Ankylosing Spondylitis Association
• Arthritis Association
• NIH/National Arthritis and Musculoskeletal & Skin Diseases Information and Clearing House
• March of Dimes Birth Defects Foundation
• Alliance of Genetic Support Groups

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