Spinal agony: ankylosing spondylitis

[Guest guest]

Spinal agony

Sunday July 23, 2006

http://thestar.com.my/health/story.asp?file=/2006/7/23/health/14899119 & sec=healt\

h

In conjunction with the 12th APLAR (Asia Pacific League of Associations for

Rheumatology) Congress, which will be held on Aug 1-5 at the Kuala Lumpur

Convention Centre, KLCC, Kuala Lumpur, we're running a series of articles on

rheumatology. This week, we take a look at ankylosing spondylitis.

EVERY day, Xilas Ngang wakes up wondering where the pain will be. Today, it

could be in his shoulder, tomorrow his knee or his pelvis. If he is

fortunate, there will be no pain, but he will feel tired and lack energy to

do daily activities.

Ngang has ankylosing spondylitis (ankylosing = fusing together; spondylitis

= inflammation of the vertebrae), a form of arthritis that mainly affects

the joints in the spine.

" The pain is kind of like inside the bone, it's very painful, " he says,

trying to describe the agony he goes through on days when his disease is

" active " .

Although 25-year-old Ngang, who works as the executive secretary of MCA's

Crisis Relief Squad, is still mobile and leads a normal, functional life,

things have certainly changed for him.

" I have forgotten how it feels to run, " he says wistfully.

Inflamed spine

As with all forms of arthritis, ankylosing spondylitis (AS) causes

inflammation of the joints.

In AS, the inflammation usually occurs in the little joints between the

vertebrae of the spine. It usually starts at the sacro-iliac joints that lie

between the sacrum and the pelvis.

" AS sometimes affects the knees and hips as well, " says consultant

rheumatologist Dr Yeap Swan Sim.

AS tends to affect more males than females, although it is not known why

this occurs.

As it is a rare disease, AS often raises puzzled eyebrows among the general

public. It affects only one in 200 people in the West, and probably half

that figure in Malaysia (estimated).

Although its cause remains unknown, AS is believed to have a genetic basis.

" People who have AS (about 90%) tend to have the HLA-B27 genetic marker.

However, this gene is also present in about 20% of the normal population;

this means you can have the gene without having AS, " Dr Yeap explains.

Testing for this genetic marker is usually carried out to confirm the

diagnosis of AS, not to screen for the disease.

Stiffness and pain

Youthful, fresh-faced Ngang is the last person you would expect to have a

debilitating, chronic joint disease. That is the cruel reality of AS, which

strikes down able-bodied, young adults in their prime.

" It is most common in young men between the age of 20 and 40, " says Dr Yeap,

who has had patients who have suffered back pains on and off, from the age

of 15.

" I started getting the pains last year. Every two to three months, the pain

would come, last for two to three days, and then go away, " says Ngang.

Most people with AS first notice that they have a bit of back or neck pain

that comes and goes. Then they may progressively get more and more stiff.

" The stiffness is caused by the joints (of the spine or neck) fusing

together, " says Dr Yeap. The repeated cycles of inflammation and healing

causes new bone to develop and fuse the joints together.

" In the end stages, their spine (may) become so stiff that they can't bend

backwards, forwards or touch their toes. If the stiffness goes to the neck,

it becomes more problematic, because they can't turn their neck sideways,

can't look up or look down.

" The stiffness may also spread to the hips or the knees, making it difficult

to walk. If this inflammation is not treated, then it can start to destroy

the cartilage and the bones. "

This could go on for about five to 10 years before they seek the help of a

doctor or a rheumatologist, she adds.

Early this year, Ngang started experiencing continuous pain in the various

affected joints of his body, making it almost impossible to walk or move at

times.

Despite the obvious pain, however, most of the doctors who examined him

could not discover the problem and told him that it was " nothing " .

" The pain is so bad that I cannot walk, and they tell me it's nothing? I

cannot accept that, " he relates.

After numerous x-rays, blood tests and even an MRI, all the other

possibilities were eliminated and he was finally diagnosed with AS.

" At least now that I know it's ankylosing spondylitis, I can prepare myself.

I know what is causing the pain, what are the effects of the disease and

whether it can be cured or not, " says Ngang.

Controlling AS

There is no cure for AS, a life-long condition that will wax and wane over

time.

" The mainstay of treatment is painkillers (non-steroidal anti-inflammatory

drugs, NSAIDs) to relieve the pain and inflammation, " says Dr Yeap.

An equally crucial part of treatment is regular exercise to keep the spine

mobile.

" Exercise is one of the important things we emphasise - stretching to get

the spine mobile and moving. Patients usually prefer if the doctor can give

them medicine to make them feel better, " Dr Yeap smiles. " But they have to

do the exercises regularly. "

" I also have to make sure that my posture is always right, " Ngang says.

People with AS have to keep their spines straight and stay as erect as

possible, even when sitting or lying down.

The medications used in rheumatoid arthritis, namely the disease-modifying

anti-rheumatic drugs or DMARDs, can be used if painkillers are unable to

control the inflammation. However, Dr Yeap notes that most drugs used in

rheumatoid arthritis do not work so well on the spine.

" For the spine, the best results so far have been with TNF-alpha inhibitors

(etanercept and infliximab). These block the inflammatory pathway, by

blocking one of the cytokines called TNF-alpha. These are a

breakthrough...unfortunately, you will soon find out that they are very

expensive, " says Dr Yeap.

All these treatment options, particularly the exercise aspect, are long-term

strategies.

If the inflammation is not controlled, it can spread to the lungs, the eyes

and the heart, causing problems in these organs.

However, thanks to modern advances in treatment, AS can be controlled and

the risk of complications is greatly reduced.

Ups and downs

Ngang recalls that when he first learned about AS, he felt like he was at a

crossroads. " I didn't know where I was. I didn't know if or when I would

recover. I didn't know whether I should work or rest, " he admits.

" My employers encouraged me to continue working. They allow me to come in to

the office slightly later, and I can rest if the pain is really bad. "

He is glad that he is back at work. " If I just rest at home, I will lose

motivation. "

Life still goes on for him, although he is not as active as he used to be.

The pain prohibits him from running or jumping, so he has stopped playing

badminton and going to the gym.

" See, I look quite normal, right? " he says, walking towards his desk without

any noticeable trouble. " But if I wake up with pain in my knee, then I need

the tongkat, " he points to the black walking stick resting against the

table.

Ngang used to go to disaster areas to provide assistance, such as Kedah

during the floods (his job involves recruiting and coordinating MCA's crisis

relief teams during disasters), but now he is more confined to the desk.

Sleep is often elusive for Ngang, who tends to wake up at least two to three

times in a night. " There was even a time when I was very scared to go to

sleep. You don't know what time you'll wake up. When you wake up, you cannot

go back to sleep, and then you'll feel the pain. "

There are good days and bad days for him. On a bad day, if his neck is

stiff, he will have trouble driving, because he cannot turn his head.

" The hardest thing is not knowing when and where the pain will come. I have

to take painkillers every day, if (not), the pain will come back and I

cannot walk or move at all, " says Ngang, who keeps spare medication in the

car, at home and at work.

" My doctor has also told me that these painkillers will cause side effects

and other problems in the future. I worry about this as well, but I have no

choice. "

Ngang has adjusted admirably to having AS. " My doctor has told me that this

is a lifelong disease, so I have to be prepared, " he says.

" With modern treatment, people with AS should be able to lead a reasonably

normal life. Quite often, the disease will burn out by itself, " Dr Yeap

shares.

She advises people who have persistent, unexplained back or neck pain that

comes and goes, and lasts for more than six months, to see a rheumatologist,

particularly if they have a family history of ankylosing spondylitis.

Note: The 12th APLAR will see members of international rheumatology

societies from around the world gather to share their experiences in the

field of rheumatology. Some of the most prominent rheumatologists from all

over the world will be in Kuala Lumpur to offer their insights and share

their experiences with their colleagues.

[Guest guest]

Thanks for posting this Georgina. I have forwarded it to Chris' email. I

think he needs to educate himself on the disease to make better

decisions about his health care. Hope all is well with you and yours,

Michele ( 19, spondy)

________________________________

From: [mailto: ] On

Behalf Of Georgina

Sent: Monday, July 24, 2006 1:18 AM

*JRA List

Subject: Spinal agony: ankylosing spondylitis

Spinal agony

Sunday July 23, 2006

http://thestar.com.my/health/story.asp?file=/2006/7/23/health/14899119 & s

ec=health

<http://thestar.com.my/health/story.asp?file=/2006/7/23/health/14899119 &

sec=health>

In conjunction with the 12th APLAR (Asia Pacific League of Associations

for

Rheumatology) Congress, which will be held on Aug 1-5 at the Kuala

Lumpur

Convention Centre, KLCC, Kuala Lumpur, we're running a series of

articles on

rheumatology. This week, we take a look at ankylosing spondylitis.

EVERY day, Xilas Ngang wakes up wondering where the pain will be. Today,

it

could be in his shoulder, tomorrow his knee or his pelvis. If he is

fortunate, there will be no pain, but he will feel tired and lack energy

to

do daily activities.

Ngang has ankylosing spondylitis (ankylosing = fusing together;

spondylitis

= inflammation of the vertebrae), a form of arthritis that mainly

affects

the joints in the spine.

" The pain is kind of like inside the bone, it's very painful, " he says,

trying to describe the agony he goes through on days when his disease is

" active " .

Although 25-year-old Ngang, who works as the executive secretary of

MCA's

Crisis Relief Squad, is still mobile and leads a normal, functional

life,

things have certainly changed for him.

" I have forgotten how it feels to run, " he says wistfully.

Inflamed spine

As with all forms of arthritis, ankylosing spondylitis (AS) causes

inflammation of the joints.

In AS, the inflammation usually occurs in the little joints between the

vertebrae of the spine. It usually starts at the sacro-iliac joints that

lie

between the sacrum and the pelvis.

" AS sometimes affects the knees and hips as well, " says consultant

rheumatologist Dr Yeap Swan Sim.

AS tends to affect more males than females, although it is not known why

this occurs.

As it is a rare disease, AS often raises puzzled eyebrows among the

general

public. It affects only one in 200 people in the West, and probably half

that figure in Malaysia (estimated).

Although its cause remains unknown, AS is believed to have a genetic

basis.

" People who have AS (about 90%) tend to have the HLA-B27 genetic marker.

However, this gene is also present in about 20% of the normal

population;

this means you can have the gene without having AS, " Dr Yeap explains.

Testing for this genetic marker is usually carried out to confirm the

diagnosis of AS, not to screen for the disease.

Stiffness and pain

Youthful, fresh-faced Ngang is the last person you would expect to have

a

debilitating, chronic joint disease. That is the cruel reality of AS,

which

strikes down able-bodied, young adults in their prime.

" It is most common in young men between the age of 20 and 40, " says Dr

Yeap,

who has had patients who have suffered back pains on and off, from the

age

of 15.

" I started getting the pains last year. Every two to three months, the

pain

would come, last for two to three days, and then go away, " says Ngang.

Most people with AS first notice that they have a bit of back or neck

pain

that comes and goes. Then they may progressively get more and more

stiff.

" The stiffness is caused by the joints (of the spine or neck) fusing

together, " says Dr Yeap. The repeated cycles of inflammation and healing

causes new bone to develop and fuse the joints together.

" In the end stages, their spine (may) become so stiff that they can't

bend

backwards, forwards or touch their toes. If the stiffness goes to the

neck,

it becomes more problematic, because they can't turn their neck

sideways,

can't look up or look down.

" The stiffness may also spread to the hips or the knees, making it

difficult

to walk. If this inflammation is not treated, then it can start to

destroy

the cartilage and the bones. "

This could go on for about five to 10 years before they seek the help of

a

doctor or a rheumatologist, she adds.

Early this year, Ngang started experiencing continuous pain in the

various

affected joints of his body, making it almost impossible to walk or move

at

times.

Despite the obvious pain, however, most of the doctors who examined him

could not discover the problem and told him that it was " nothing " .

" The pain is so bad that I cannot walk, and they tell me it's nothing? I

cannot accept that, " he relates.

After numerous x-rays, blood tests and even an MRI, all the other

possibilities were eliminated and he was finally diagnosed with AS.

" At least now that I know it's ankylosing spondylitis, I can prepare

myself.

I know what is causing the pain, what are the effects of the disease and

whether it can be cured or not, " says Ngang.

Controlling AS

There is no cure for AS, a life-long condition that will wax and wane

over

time.

" The mainstay of treatment is painkillers (non-steroidal

anti-inflammatory

drugs, NSAIDs) to relieve the pain and inflammation, " says Dr Yeap.

An equally crucial part of treatment is regular exercise to keep the

spine

mobile.

" Exercise is one of the important things we emphasise - stretching to

get

the spine mobile and moving. Patients usually prefer if the doctor can

give

them medicine to make them feel better, " Dr Yeap smiles. " But they have

to

do the exercises regularly. "

" I also have to make sure that my posture is always right, " Ngang says.

People with AS have to keep their spines straight and stay as erect as

possible, even when sitting or lying down.

The medications used in rheumatoid arthritis, namely the

disease-modifying

anti-rheumatic drugs or DMARDs, can be used if painkillers are unable to

control the inflammation. However, Dr Yeap notes that most drugs used in

rheumatoid arthritis do not work so well on the spine.

" For the spine, the best results so far have been with TNF-alpha

inhibitors

(etanercept and infliximab). These block the inflammatory pathway, by

blocking one of the cytokines called TNF-alpha. These are a

breakthrough...unfortunately, you will soon find out that they are very

expensive, " says Dr Yeap.

All these treatment options, particularly the exercise aspect, are

long-term

strategies.

If the inflammation is not controlled, it can spread to the lungs, the

eyes

and the heart, causing problems in these organs.

However, thanks to modern advances in treatment, AS can be controlled

and

the risk of complications is greatly reduced.

Ups and downs

Ngang recalls that when he first learned about AS, he felt like he was

at a

crossroads. " I didn't know where I was. I didn't know if or when I would

recover. I didn't know whether I should work or rest, " he admits.

" My employers encouraged me to continue working. They allow me to come

in to

the office slightly later, and I can rest if the pain is really bad. "

He is glad that he is back at work. " If I just rest at home, I will lose

motivation. "

Life still goes on for him, although he is not as active as he used to

be.

The pain prohibits him from running or jumping, so he has stopped

playing

badminton and going to the gym.

" See, I look quite normal, right? " he says, walking towards his desk

without

any noticeable trouble. " But if I wake up with pain in my knee, then I

need

the tongkat, " he points to the black walking stick resting against the

table.

Ngang used to go to disaster areas to provide assistance, such as Kedah

during the floods (his job involves recruiting and coordinating MCA's

crisis

relief teams during disasters), but now he is more confined to the desk.

Sleep is often elusive for Ngang, who tends to wake up at least two to

three

times in a night. " There was even a time when I was very scared to go to

sleep. You don't know what time you'll wake up. When you wake up, you

cannot

go back to sleep, and then you'll feel the pain. "

There are good days and bad days for him. On a bad day, if his neck is

stiff, he will have trouble driving, because he cannot turn his head.

" The hardest thing is not knowing when and where the pain will come. I

have

to take painkillers every day, if (not), the pain will come back and I

cannot walk or move at all, " says Ngang, who keeps spare medication in

the

car, at home and at work.

" My doctor has also told me that these painkillers will cause side

effects

and other problems in the future. I worry about this as well, but I have

no

choice. "

Ngang has adjusted admirably to having AS. " My doctor has told me that

this

is a lifelong disease, so I have to be prepared, " he says.

" With modern treatment, people with AS should be able to lead a

reasonably

normal life. Quite often, the disease will burn out by itself, " Dr Yeap

shares.

She advises people who have persistent, unexplained back or neck pain

that

comes and goes, and lasts for more than six months, to see a

rheumatologist,

particularly if they have a family history of ankylosing spondylitis.

Note: The 12th APLAR will see members of international rheumatology

societies from around the world gather to share their experiences in the

field of rheumatology. Some of the most prominent rheumatologists from

all

over the world will be in Kuala Lumpur to offer their insights and share

their experiences with their colleagues.

[Guest guest]

Hi Michele,

I hope he'll be open to at least reading it. Josh, at 17, now thinks he knows

better than most people all there is to know about the systemic type of juvenile

arthritis. To quote Bob Marley, " He who feels it, knows it " He's still pleased

that I'm helping to share the latest arthritis related news and stories through

our online group but very few of the articles seem to interest him - except the

ones featuring children from this group, whose names he's already heard. Last

year he needed info for a class project so he browsed through the archives and

read up on some stuff ... but he seems a bit reluctant and somehow not quite as

interested in it as I am. I told him about the kids email group and he was not

at all into it, even though I told him his experiences might really help others.

He wrote up a speech for a AF fundraiser meeting that came from the heart and he

felt good about speaking in front of that group but it's not something he wants

to be involved in on a daily basis. He's busy doing his own thing.

He's doing good, though. Has been having a few bothersome joints, elbows and

knees mostly, but not too bad. They seemed to start 'acting up' once he switched

from Indomethacin to Sulindac. Helen was right. Hawaii just took a little bit

longer to use up it's reserves but the shortage eventually hit us too and he had

to try something new. The doctor told him to take twice the starting dose to see

if that helped better but when I looked at his pill box, I saw that he was

leaving 1 of the pills untouched. That may change though because last night he

came in my room to show me the rash he had on his side and back.

I'm just keeping my fingers crossed that ALL will be well by next week, when

school starts for the kids here!

Aloha,

Georgina

Spinal agony: ankylosing spondylitis

Spinal agony

Sunday July 23, 2006

http://thestar.com.my/health/story.asp?file=/2006/7/23/health/14899119 & s

ec=health

<http://thestar.com.my/health/story.asp?file=/2006/7/23/health/14899119 &

sec=health>

In conjunction with the 12th APLAR (Asia Pacific League of Associations

for

Rheumatology) Congress, which will be held on Aug 1-5 at the Kuala

Lumpur

Convention Centre, KLCC, Kuala Lumpur, we're running a series of

articles on

rheumatology. This week, we take a look at ankylosing spondylitis.

EVERY day, Xilas Ngang wakes up wondering where the pain will be. Today,

it

could be in his shoulder, tomorrow his knee or his pelvis. If he is

fortunate, there will be no pain, but he will feel tired and lack energy

to

do daily activities.

Ngang has ankylosing spondylitis (ankylosing = fusing together;

spondylitis

= inflammation of the vertebrae), a form of arthritis that mainly

affects

the joints in the spine.

" The pain is kind of like inside the bone, it's very painful, " he says,

trying to describe the agony he goes through on days when his disease is

" active " .

Although 25-year-old Ngang, who works as the executive secretary of

MCA's

Crisis Relief Squad, is still mobile and leads a normal, functional

life,

things have certainly changed for him.

" I have forgotten how it feels to run, " he says wistfully.

Inflamed spine

As with all forms of arthritis, ankylosing spondylitis (AS) causes

inflammation of the joints.

In AS, the inflammation usually occurs in the little joints between the

vertebrae of the spine. It usually starts at the sacro-iliac joints that

lie

between the sacrum and the pelvis.

" AS sometimes affects the knees and hips as well, " says consultant

rheumatologist Dr Yeap Swan Sim.

AS tends to affect more males than females, although it is not known why

this occurs.

As it is a rare disease, AS often raises puzzled eyebrows among the

general

public. It affects only one in 200 people in the West, and probably half

that figure in Malaysia (estimated).

Although its cause remains unknown, AS is believed to have a genetic

basis.

" People who have AS (about 90%) tend to have the HLA-B27 genetic marker.

However, this gene is also present in about 20% of the normal

population;

this means you can have the gene without having AS, " Dr Yeap explains.

Testing for this genetic marker is usually carried out to confirm the

diagnosis of AS, not to screen for the disease.

Stiffness and pain

Youthful, fresh-faced Ngang is the last person you would expect to have

a

debilitating, chronic joint disease. That is the cruel reality of AS,

which

strikes down able-bodied, young adults in their prime.

" It is most common in young men between the age of 20 and 40, " says Dr

Yeap,

who has had patients who have suffered back pains on and off, from the

age

of 15.

" I started getting the pains last year. Every two to three months, the

pain

would come, last for two to three days, and then go away, " says Ngang.

Most people with AS first notice that they have a bit of back or neck

pain

that comes and goes. Then they may progressively get more and more

stiff.

" The stiffness is caused by the joints (of the spine or neck) fusing

together, " says Dr Yeap. The repeated cycles of inflammation and healing

causes new bone to develop and fuse the joints together.

" In the end stages, their spine (may) become so stiff that they can't

bend

backwards, forwards or touch their toes. If the stiffness goes to the

neck,

it becomes more problematic, because they can't turn their neck

sideways,

can't look up or look down.

" The stiffness may also spread to the hips or the knees, making it

difficult

to walk. If this inflammation is not treated, then it can start to

destroy

the cartilage and the bones. "

This could go on for about five to 10 years before they seek the help of

a

doctor or a rheumatologist, she adds.

Early this year, Ngang started experiencing continuous pain in the

various

affected joints of his body, making it almost impossible to walk or move

at

times.

Despite the obvious pain, however, most of the doctors who examined him

could not discover the problem and told him that it was " nothing " .

" The pain is so bad that I cannot walk, and they tell me it's nothing? I

cannot accept that, " he relates.

After numerous x-rays, blood tests and even an MRI, all the other

possibilities were eliminated and he was finally diagnosed with AS.

" At least now that I know it's ankylosing spondylitis, I can prepare

myself.

I know what is causing the pain, what are the effects of the disease and

whether it can be cured or not, " says Ngang.

Controlling AS

There is no cure for AS, a life-long condition that will wax and wane

over

time.

" The mainstay of treatment is painkillers (non-steroidal

anti-inflammatory

drugs, NSAIDs) to relieve the pain and inflammation, " says Dr Yeap.

An equally crucial part of treatment is regular exercise to keep the

spine

mobile.

" Exercise is one of the important things we emphasise - stretching to

get

the spine mobile and moving. Patients usually prefer if the doctor can

give

them medicine to make them feel better, " Dr Yeap smiles. " But they have

to

do the exercises regularly. "

" I also have to make sure that my posture is always right, " Ngang says.

People with AS have to keep their spines straight and stay as erect as

possible, even when sitting or lying down.

The medications used in rheumatoid arthritis, namely the

disease-modifying

anti-rheumatic drugs or DMARDs, can be used if painkillers are unable to

control the inflammation. However, Dr Yeap notes that most drugs used in

rheumatoid arthritis do not work so well on the spine.

" For the spine, the best results so far have been with TNF-alpha

inhibitors

(etanercept and infliximab). These block the inflammatory pathway, by

blocking one of the cytokines called TNF-alpha. These are a

breakthrough...unfortunately, you will soon find out that they are very

expensive, " says Dr Yeap.

All these treatment options, particularly the exercise aspect, are

long-term

strategies.

If the inflammation is not controlled, it can spread to the lungs, the

eyes

and the heart, causing problems in these organs.

However, thanks to modern advances in treatment, AS can be controlled

and

the risk of complications is greatly reduced.

Ups and downs

Ngang recalls that when he first learned about AS, he felt like he was

at a

crossroads. " I didn't know where I was. I didn't know if or when I would

recover. I didn't know whether I should work or rest, " he admits.

" My employers encouraged me to continue working. They allow me to come

in to

the office slightly later, and I can rest if the pain is really bad. "

He is glad that he is back at work. " If I just rest at home, I will lose

motivation. "

Life still goes on for him, although he is not as active as he used to

be.

The pain prohibits him from running or jumping, so he has stopped

playing

badminton and going to the gym.

" See, I look quite normal, right? " he says, walking towards his desk

without

any noticeable trouble. " But if I wake up with pain in my knee, then I

need

the tongkat, " he points to the black walking stick resting against the

table.

Ngang used to go to disaster areas to provide assistance, such as Kedah

during the floods (his job involves recruiting and coordinating MCA's

crisis

relief teams during disasters), but now he is more confined to the desk.

Sleep is often elusive for Ngang, who tends to wake up at least two to

three

times in a night. " There was even a time when I was very scared to go to

sleep. You don't know what time you'll wake up. When you wake up, you

cannot

go back to sleep, and then you'll feel the pain. "

There are good days and bad days for him. On a bad day, if his neck is

stiff, he will have trouble driving, because he cannot turn his head.

" The hardest thing is not knowing when and where the pain will come. I

have

to take painkillers every day, if (not), the pain will come back and I

cannot walk or move at all, " says Ngang, who keeps spare medication in

the

car, at home and at work.

" My doctor has also told me that these painkillers will cause side

effects

and other problems in the future. I worry about this as well, but I have

no

choice. "

Ngang has adjusted admirably to having AS. " My doctor has told me that

this

is a lifelong disease, so I have to be prepared, " he says.

" With modern treatment, people with AS should be able to lead a

reasonably

normal life. Quite often, the disease will burn out by itself, " Dr Yeap

shares.

She advises people who have persistent, unexplained back or neck pain

that

comes and goes, and lasts for more than six months, to see a

rheumatologist,

particularly if they have a family history of ankylosing spondylitis.

Note: The 12th APLAR will see members of international rheumatology

societies from around the world gather to share their experiences in the

field of rheumatology. Some of the most prominent rheumatologists from

all

over the world will be in Kuala Lumpur to offer their insights and share

their experiences with their colleagues.