OBJECTIVE: This report describes chiropractic management for 3 cases of inactive ankylosing spondylitis (AS). CLINICAL FEATURES: A 25-year-old woman presented with chronic, mechanical neck pain and stiffness that was ultimately diagnosed as AS. A 23-year-old man presented with chronic low back and left hip pain that was diagnosed as AS. A 31-year-old man with low back pain presented with a known diagnosis of AS. Physical examination in 2 cases failed to identify systemic findings associated with AS. In the third case, examination revealed a history of ulcerative colitis. Laboratory examination of case 2 yielded a positive HLA-B27, but cases 1 and 3 were HLA-B27 negative. The acute reactants were negative in all 3 patients, indicating an inactive phase of disease. All 3 patients underwent spinal imaging including sacroiliac joint radiography. In case 3, magnetic resonance imaging of the sacroiliac joints was performed. All 3 imaging examinations revealed bilateral, symmetric sacroiliitis. INTERVENTIONS AND OUTCOME: Patients were managed by both a medical rheumatologist and a doctor of chiropractic. Chiropractic care ranged from instrument-assisted spinal manipulation to diversified spinal and soft tissue manipulation and Cox flexion-distraction. Patients were given home stretches and rehabilitation exercises. All 3 patients experienced some relief of their symptoms including pain reduction and improved activities of daily living. CONCLUSION: These 3 patients displayed differences and commonalities in clinical, laboratory, and imaging features. Chiropractic manipulation and rehabilitation seemed to be beneficial in reducing symptomatology and improving musculoskeletal function for these 3 patients. These findings suggest the potential for collaborative or integrative management in similar cases.
OBJECTIVE: This report describes chiropractic management for 3 cases of inactive ankylosing spondylitis (AS). CLINICAL FEATURES: A 25-year-old woman presented with chronic, mechanical neck pain and stiffness that was ultimately diagnosed as AS. A 23-year-old man presented with chronic low back and left hip pain that was diagnosed as AS. A 31-year-old man with low back pain presented with a known diagnosis of AS. Physical examination in 2 cases failed to identify systemic findings associated with AS. In the third case, examination revealed a history of ulcerative colitis. Laboratory examination of case 2 yielded a positive HLA-B27, but cases 1 and 3 were HLA-B27 negative. The acute reactants were negative in all 3 patients, indicating an inactive phase of disease. All 3 patients underwent spinal imaging including sacroiliac joint radiography. In case 3, magnetic resonance imaging of the sacroiliac joints was performed. All 3 imaging examinations revealed bilateral, symmetric sacroiliitis. INTERVENTIONS AND OUTCOME: Patients were managed by both a medical rheumatologist and a doctor of chiropractic. Chiropractic care ranged from instrument-assisted spinal manipulation to diversified spinal and soft tissue manipulation and Cox flexion-distraction. Patients were given home stretches and rehabilitation exercises. All 3 patients experienced some relief of their symptoms including pain reduction and improved activities of daily living. CONCLUSION: These 3 patients displayed differences and commonalities in clinical, laboratory, and imaging features. Chiropractic manipulation and rehabilitation seemed to be beneficial in reducing symptomatology and improving musculoskeletal function for these 3 patients. These findings suggest the potential for collaborative or integrative management in similar cases.
Authors: Philip C Robinson; Mary-Ellen Costello; Paul Leo; Linda A Bradbury; Kelly Hollis; Adrian Cortes; Seunghun Lee; Kyung Bin Joo; Seung-Cheol Shim; Michael Weisman; Michael Ward; Xiaodong Zhou; Henri-Jean Garchon; Gilles Chiocchia; Johannes Nossent; Benedicte A Lie; Øystein Førre; Jaakko Tuomilehto; Kari Laiho; Lei Jiang; Yu Liu; Xin Wu; Dirk Elewaut; Ruben Burgos-Vargas; Lianne S Gensler; Simon Stebbings; Nigil Haroon; Juan Mulero; Jose Luis Fernandez-Sueiro; Miguel A Gonzalez-Gay; Carlos Lopez-Larrea; Paul Bowness; Karl Gafney; John S Hill Gaston; Dafna D Gladman; Proton Rahman; Walter P Maksymowych; Huji Xu; Irene E van der Horst-Bruinsma; Chung-Tei Chou; Raphael Valle-Oñate; María Consuelo Romero-Sánchez; Inger Myrnes Hansen; Fernando M Pimentel-Santos; Robert D Inman; Javier Martin; Maxime Breban; David Evans; John D Reveille; Tae-Hwan Kim; B Paul Wordsworth; Matthew A Brown Journal: Ann Rheum Dis Date: 2015-04-27 Impact factor: 19.103
Authors: Nigil Haroon; Robert D Inman; Thomas J Learch; Michael H Weisman; MinJae Lee; Mohammad H Rahbar; Michael M Ward; John D Reveille; Lianne S Gensler Journal: Arthritis Rheum Date: 2013-10