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Arthritis
Volume 2011 (2011), Article ID 205904, 10 pages
http://dx.doi.org/10.1155/2011/205904
Review Article

Integrative Structural Biomechanical Concepts of Ankylosing Spondylitis

1Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61656, USA
2Department of Mechanical Engineering, Bradley University, Peoria, IL 61625, USA
3Department of Physical Therapy & Health Science, Bradley University, Peoria, IL 61625, USA
4Department of Electrical and Computer Engineering, Bradley University, Peoria, IL 61625, USA

Received 31 August 2011; Revised 6 October 2011; Accepted 7 October 2011

Academic Editor: Ruben Burgos-Vargas

Copyright © 2011 Alfonse T. Masi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ankylosing spondylitis (AS) is not fully explained by inflammatory processes. Clinical, epidemiological, genetic, and course of disease features indicate additional host-related risk processes and predispositions. Collectively, the pattern of predisposition to onset in adolescent and young adult ages, male preponderance, and widely varied severity of AS is unique among rheumatic diseases. However, this pattern could reflect biomechanical and structural differences between the sexes, naturally occurring musculoskeletal changes over life cycles, and a population polymorphism. During juvenile development, the body is more flexible and weaker than during adolescent maturation and young adulthood, when strengthening and stiffening considerably increase. During middle and later ages, the musculoskeletal system again weakens. The novel concept of an innate axial myofascial hypertonicity reflects basic mechanobiological principles in human function, tissue reactivity, and pathology. However, these processes have been little studied and require critical testing. The proposed physical mechanisms likely interact with recognized immunobiological pathways. The structural biomechanical processes and tissue reactions might possibly precede initiation of other AS-related pathways. Research in the combined structural mechanobiology and immunobiology processes promises to improve understanding of the initiation and perpetuation of AS than prevailing concepts. The combined processes might better explain characteristic enthesopathic and inflammatory processes in AS.