11 - 20 of 325 Diseases

Addison’s disease
of glands


Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands.

The adrenal glands are 2 small glands that sit on top of the kidneys. They produce essential hormones: cortisol, aldosterone and adrenaline.

In Addison’s disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced.

About 8,400 people in the UK have Addison’s disease. It can affect people of any age. It’s most common between the ages of 30 and 50. It’s also more common in women than men.

Early-stage symptoms of Addison’s disease are similar to other more common health conditions, such as depression or flu. You may experience:

fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst

Over time, these problems may become more severe and you may experience further symptoms, such as dizziness, fainting, cramps and exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums.

Although these symptoms aren’t always caused by Addison’s disease, you should see your GP, so they can be investigated.

Read more about the symptoms of Addison’s disease and diagnosing Addison’s disease
Symptoms


Addison’s disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions.

Initial symptoms of Addison’s disease can include:

fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods

Dehydration can also be an early sign of Addison’s disease. It’s caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water.


Further symptoms of Addison’s disease tend to develop gradually over months or years. However, additional stress, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse.

You may go on to develop:

low blood pressure when you stand up, which can cause dizziness and fainting  feeling sick (nausea) vomiting diarrhoea abdominal, joint or back pain muscle cramps  chronic exhaustion, which may cause depression brownish discolouration of the skin, lips and gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex), particularly in women

Some women may also have irregular periods or miss some periods completely. Children with Addison’s disease may experience puberty later than usual.

Some people with Addison’s disease also develop low blood sugar (hypoglycaemia). This can cause symptoms such as difficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children).

If you’re experiencing symptoms of Addison’s disease, see your GP so they can diagnose or rule out the condition. These symptoms will usually improve with appropriate treatment.

Read more about diagnosing Addison’s disease and treating Addison’s disease

Causes


The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. It’s not clear why this happens, but it’s responsible for 70% to 90% of cases in the UK.

Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB), although this is uncommon in the UK.

Read more about the causes of Addison’s disease


Addison’s disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces.


Tuberculosis (TB) is the most common cause of Addison’s disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body. It can cause Addison’s disease if it damages your adrenal glands.

Other possible causes of Addison’s disease include:

infections – such as those linked to AIDS, or fungal infections a haemorrhage – very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer – if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis – a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal of both adrenal glands (adrenalectomy) – for example, to remove a tumour adrenoleukodystrophy (ALD) – a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain that most often affects young boys certain treatments needed for Cushing’s syndrome – a collection of symptoms caused by very high levels of cortisol in the body

Diagnoses


To help diagnose Addison’s disease, your GP will first ask about your symptoms and review your medical history.

They’re also likely to ask if anyone in your family has an autoimmune disorder (a condition caused by a problem with their immune system).

Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as:

where skin creases on your palm in your elbow crease on any scars your lips and gums

However, hyperpigmentation doesn’t occur in all cases of Addison’s disease.

You’ll also be tested for low blood pressure (hypotension) while you’re lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position).


If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease.

You may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following:

a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland)

Any of these could be a sign of Addison’s disease.


If cortisol in your blood is low, or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen stimulation test to confirm the diagnosis.

Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently you’re referred depends on how severe your symptoms are.

Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone.

When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol and other steroid hormones into the blood.

A blood sample will be taken and tested for cortisol, before an injection of synacthen is given into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement.

If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease.


As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it’s working properly.

Your thyroid gland is found in your neck. It produces hormones that control your body’s growth and metabolism.

People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism.


If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely.

During an adrenal crisis, there’s not enough time to perform a synacthen stimulation test to confirm Addison’s disease.

If possible, blood will be taken and tested for any of the abnormalities listed above. While you’re waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose.

Read more about treating Addison’s disease

Treatments


Addison’s disease is treated with medication to replace the missing hormones. You’ll need to take the medication for the rest of your life.

With treatment, symptoms of Addison’s disease can largely be controlled. Most people with the condition live a normal lifespan and are able to live an active life, with few limitations.

However, many people with Addison’s disease also find they must learn to manage bouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid.

People with Addison’s disease must be aware of the risk of a sudden worsening of symptoms, called an adrenal crisis. This can happen when the levels of cortisol in your body fall significantly due to not taking your medicines, or during another illness.

An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If left untreated, it can be fatal. If you or someone you know has Addison’s disease and is experiencing severe symptoms, phone 999 for an ambulance.

Read more about treating Addison’s disease


If you have Addison’s disease, you’ll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue.

In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months.

However, most cases are caused by a problem with the immune system that can’t be cured.


You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency.

This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you’re pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary.

If you need to administer emergency hydrocortisone, always phone your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours.

You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance.


Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Phone 999 for an ambulance if you or someone you know are experiencing adrenal crisis.

Signs of an adrenal crisis include:

severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness

In hospital, you’ll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. You’ll also be injected with hydrocortisone to replace the missing cortisol hormone.

Any underlying causes of the adrenal crisis, such as an infection, will also be treated.

Alcohol-related liver disease
of stomach liver and gastrointestinal tract


Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.

ARLD doesn’t usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include:

feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the ankles and tummy confusion or drowsiness vomiting blood or passing blood in your stools

This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.

If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.

Read more about:

symptoms of ARLD diagnosing ARLD
Symptoms


In many cases, people with alcohol-related liver disease (ARLD) don’t have any noticeable symptoms until their liver is badly damaged.


If you do experience early symptoms of ARLD, these are often quite vague, such as:

abdominal pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell


As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as:

yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due to a build-up of fluid (oedema) swelling in your abdomen, due to a build-up of fluid known as ascites a high temperature (fever) and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy red palms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping (insomnia) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due to internal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver can’t process them)


If you’re abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3 to 7 days from the time of your last drink.

Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases their sleep pattern returns to normal within a month.

In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offered a medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process.

Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, so their progress can be closely monitored.

If you’re staying at home, you’ll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service.


The use of medication to directly treat ARLD is controversial. Many experts have argued there’s limited evidence for its effectiveness.

For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids or pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition.

Nutritional support is also an important part of treatment in these cases.

Other medications that have been used to treat liver damage include:

anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands)

However, there’s a lack of good evidence that these help and they’re no longer used for severe alcoholic hepatitis.

Causes


Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD.

There are 2 ways alcohol misuse (drinking too much) can cause ARLD. These are:

drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can cause hepatitis and cirrhosis, the more serious types of ARLD

Evidence suggests people who regularly drink more than the recommended maximum amounts are most at risk of developing ARLD.

Read more about alcohol units and how to calculate them.

Diagnoses


Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

This is because the condition causes few obvious symptoms in the early stages.

If a doctor suspects ARLD, they’ll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption.

It’s important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need.


Blood tests used to assess the liver are known as liver function tests. However, liver function tests can be normal at many stages of liver disease.

Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isn’t functioning properly.

A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.

Lab Tests Online has more information on liver function tests.


If your symptoms or liver function test suggest an advanced form of ARLD – either alcoholic hepatitis or cirrhosis – you may need further tests.


Scans may be needed to produce detailed images of your liver. This may include:

an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan

Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.

Treatments


There’s currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering.

If a person is dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services.

A liver transplant may be required in severe cases where the liver has stopped functioning and doesn’t improve when you stop drinking alcohol.

You’ll only be considered for a liver transplant if you’ve developed complications of cirrhosis, despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life.

Read more about treating ARLD.


ARLD doesn’t often cause symptoms until it’s reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of these symptoms.

Read about alcohol misuse (drinking too much). 

Contact your GP for advice if you have a history of regular alcohol misuse.

A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions:

Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an ‘eye-opener’, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves?

If you answer yes to 1 or more of the questions, you may have an alcohol problem and are advised to see your GP.

See your GP as soon as possible if you have symptoms of advanced ARLD.

Read more about how ARLD is diagnosed.


Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle.

Preventions


The most effective way to prevent ARLD is to stop drinking alcohol or stick to the low-risk drinking guidelines.

Even if you’ve been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health.

Read our drinking and alcohol pages for more information and advice.


Once you’ve stopped drinking, you may need further treatment to help ensure you don’t start drinking again.

The first treatment usually offered is psychological therapy. This involves seeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing.

If psychological therapy alone isn’t effective, you may also need medication to help you abstain from alcohol, such as: 

acamprosate naltrexone disulfiram

Read our page on treating alcohol misuse for more information on the treatments offered.

Complications


Death rates linked to ARLD have risen considerably over the last few decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure.

Life-threatening complications of ARLD include:

internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer

Read more about the complications of ARLD.


A number of serious complications can develop if you have alcohol-related liver disease (ARLD).

Allergic rhinitis
of ears nose and throat


Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals.

It’s a very common condition, estimated to affect around one in every five people in the UK.
Symptoms


Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen.

Some people only get allergic rhinitis for a few months at a time because they’re sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round.

Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. But for some symptoms can be severe and persistent, causing sleep problems and interfering with everyday life.

The symptoms of allergic rhinitis occasionally improve with time, but this can take many years and it’s unlikely that the condition will disappear completely.

Causes


Allergic rhinitis is caused by the immune system reacting to an allergen as if it were harmful.

This results in cells releasing a number of chemicals that cause the inside layer of your nose (the mucous membrane) to become swollen and excessive levels of mucus to be produced.

Common allergens that cause allergic rhinitis include pollen – this type of allergic rhinitis is known as hay fever – as well as mould spores, house dust mites, and flakes of skin or droplets of urine or saliva from certain animals.

Read more about the causes of allergic rhinitis


Allergic rhinitis is caused by an allergic reaction to an allergen, such as pollen, dust and certain animals.

Diagnoses


Your GP will often be able to diagnose allergic rhinitis from your symptoms and your personal and family medical history.

They’ll ask you whether you’ve noticed any triggers that seem to cause a reaction, and whether it happens at a particular place or time.

Your GP may examine the inside of your nose to check for nasal polyps.

Nasal polyps are fleshy swellings that grow from the lining of your nose or your sinuses, the small cavities inside your nose. They can be caused by the inflammation that occurs as a result of allergic rhinitis.

Allergic rhinitis is usually confirmed when medical treatment starts. If you respond well to antihistamines, it’s almost certain that your symptoms are caused by an allergy.


If the exact cause of allergic rhinitis is uncertain, your GP may refer you to a hospital allergy clinic for allergy testing.

The two main allergy tests are:

skin prick test – where the allergen is placed on your arm and the surface of the skin is pricked with a needle to introduce the allergen to your immune system; if you’re allergic to the substance, a small itchy spot (welt) will appear blood test – to check for the immunoglobulin E (IgE) antibody in your blood; your immune system produces this antibody in response to a suspected allergen

Commercial allergy testing kits aren’t recommended because the testing is often of a lower standard than that provided by the NHS or an accredited private clinic.

It’s also important that the test results are interpreted by a qualified healthcare professional with detailed knowledge of your symptoms and medical history.


In some cases further hospital tests may be needed to check for complications, such as nasal polyps or sinusitis.

For example, you may need:

a nasal endoscopy – where a thin tube with a light source and video camera at one end (endoscope) is inserted up your nose so your doctor can see inside your nose a nasal inspiratory flow test – where a small device is placed over your mouth and nose to measure the air flow when you inhale through your nose a computerised tomography (CT) scan – a scan that uses X-rays and a computer to create detailed images of the inside of the body

Treatments


Visit your GP if the symptoms of allergic rhinitis are disrupting your sleep, preventing you carrying out everyday activities, or adversely affecting your performance at work or school.

A diagnosis of allergic rhinitis will usually be based on your symptoms and any possible triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing.

Read more about diagnosing allergic rhinitis


It’s difficult to completely avoid potential allergens, but you can take steps to reduce exposure to a particular allergen you know or suspect is triggering your allergic rhinitis. This will help improve your symptoms.

If your condition is mild, you can also help reduce the symptoms by taking over-the-counter medications, such as non-sedating antihistamines, and by regularly rinsing your nasal passages with a salt water solution to keep your nose free of irritants.

See your GP for advice if you’ve tried taking these steps and they haven’t helped. They may prescribe a stronger medication, such as a nasal spray containing corticosteroids.

Read more about treating allergic rhinitis and preventing allergic rhinitis


Treatment for allergic rhinitis depends on how severe your symptoms are and how much they’re affecting your everyday activities.

In most cases treatment aims to relieve symptoms such as sneezing and a blocked or runny nose.

If you have mild allergic rhinitis, you can often treat the symptoms yourself. 

You should visit your GP if your symptoms are more severe and affecting your quality of life, or if self-help measures haven’t been effective.

Preventions


It’s difficult to completely avoid potential allergens, but you can take steps to reduce exposure to a particular allergen you know or suspect is triggering your allergic rhinitis. This will help improve your symptoms.

If your condition is mild, you can also help reduce the symptoms by taking over-the-counter medications, such as non-sedating antihistamines, and by regularly rinsing your nasal passages with a salt water solution to keep your nose free of irritants.

See your GP for advice if you’ve tried taking these steps and they haven’t helped. They may prescribe a stronger medication, such as a nasal spray containing corticosteroids.

Read more about treating allergic rhinitis and preventing allergic rhinitis


The best way to prevent allergic rhinitis is to avoid the allergen that causes it.

But this isn’t always easy. Allergens, such as dust mites, aren’t always easy to spot and can breed in even the cleanest house.

It can also be difficult to avoid coming into contact with pets, particularly if they belong to friends and family.

Below is some advice to help you avoid the most common allergens.

Complications


If you have allergic rhinitis, there’s a risk you could develop further problems.

A blocked or runny nose can result in difficulty sleeping, drowsiness during the daytime, irritability and problems concentrating. Allergic rhinitis can also make symptoms of asthma worse.

The inflammation associated with allergic rhinitis can also sometimes lead to other conditions, such as nasal polyps, sinusitis and middle ear infections. These are described below.

Allergies
of immune system


An allergy is a reaction the body has to a particular food or substance.

Allergies are very common. They’re thought to affect more than 1 in 4 people in the UK at some point in their lives.

They are particularly common in children. Some allergies go away as a child gets older, although many are lifelong. Adults can develop allergies to things they weren’t previously allergic to.

Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon.
Symptoms


Allergic reactions usually happen quickly within a few minutes of exposure to an allergen.

They can cause:

sneezing a runny or blocked nose red, itchy, watery eyes wheezing and coughing a red, itchy rash worsening of asthma or eczema symptoms

Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. This is a medical emergency and needs urgent treatment.

Read more about the symptoms of allergies.


Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something you’re allergic to, although occasionally they can develop gradually over a few hours.

Although allergic reactions can be a nuisance and hamper your normal activities, most are mild. Very occasionally, a severe reaction called anaphylaxis can occur.


Common symptoms of an allergic reaction include:

sneezing and an itchy, runny or blocked nose (allergic rhinitis) itchy, red, watering eyes (conjunctivitis) wheezing, chest tightness, shortness of breath and a cough a raised, itchy, red rash (hives) swollen lips, tongue, eyes or face tummy pain, feeling sick, vomiting or diarrhoea dry, red and cracked skin

The symptoms vary depending on what you’re allergic to and how you come into contact with it. For example, you may have a runny nose if exposed to pollen, develop a rash if you have a skin allergy, or feel sick if you eat something you’re allergic to.

See your pharmacist if you or your child might have had an allergic reaction to something. They can help determine whether the symptoms are caused by an allergy or another condition. Read more about diagnosing allergies.

Causes


Allergies occur when the body’s immune system reacts to a particular substance as though it’s harmful.

It’s not clear why this happens, but most people affected have a family history of allergies or have closely related conditions such as asthma or eczema.

The number of people with allergies is increasing every year. The reasons for this are not understood, but one of the main theories is it’s the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with.

It’s thought this may cause it to overreact when it comes into contact with harmless substances.

Diagnoses


If you think you have an allergy, tell your pharmacist about the symptoms you’re having, when they happen, how often they occur and if anything seems to trigger them. Your pharmacist can offer advice and treatment for mild allergies with a clear cause.

If your allergy is more severe or it’s not obvious what you’re allergic to, your pharmacist may advise you to see your GP as you may need referred for allergy testing at a specialist allergy clinic.

The tests that may be carried out are described below.


Skin prick testing is one of the most common allergy tests.

It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked with a needle. If you are allergic to the substance, an itchy, red bump will appear within 15 minutes.

Skin prick testing is painless and very safe. Make sure you don’t take antihistamines before the test, as they can interfere with the results.


Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies.

A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen.


Patch tests are used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen.

A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction.


In a few cases, a test called a food challenge may also be used to diagnose a food allergy.

During the test, you’re given the food you think you’re allergic to in gradually increasing amounts, to see how you react under close supervision.

This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop.

Treatments


Pharmacy First Scotland: Allergies treatment from your pharmacyIf you have allergies you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you




The treatment for an allergy depends on what you’re allergic to. In many cases your pharmacist will be able to offer advice and treatment.

They’ll advise you about taking steps to avoid exposure to the substance you’re allergic to, and can recommend medication to control your symptoms.


Some people with severe allergies may experience life-threatening reactions, known as anaphylaxis or anaphylactic shock.

If you’re at risk of this, you’ll be given special injectors containing a medicine called adrenaline to use in an emergency.

If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help.

Read more about the treating anaphylaxis.

Preventions


The best way to prevent an allergic reaction is to avoid the substance that you’re allergic to, although this isn’t always easy or practical.

Below is some practical advice that should help you avoid the most common allergens.


If you’re at risk of experiencing a severe allergic reaction (anaphylaxis), make sure you carry two adrenaline auto-injectors with you everywhere.

Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency.

Consider telling your teachers, work colleagues and friends, so they can give you your adrenaline injection in an emergency, while waiting for an ambulance.

Read more about preventing anaphylaxis.

Alzheimer’s disease
of brain nerves and spinal cord


Alzheimer’s disease is the most common type of dementia, affecting an estimated 850,000 people in the UK.

Dementia is a progressive neurological disease which affects multiple brain functions, including memory.

The exact cause of Alzheimer’s disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include:

increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease

It’s becoming increasingly understood that it’s very common to have both changes of Alzheimer’s and vascular dementia together (mixed dementia).

Read more about the causes of Alzheimer’s disease
Symptoms


Alzheimer’s disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course of several years. It affects multiple brain functions.

The first sign of Alzheimer’s disease is usually minor memory problems. For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects.

As the condition develops, memory problems become more severe and further symptoms can develop, such as:

confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations (seeing or hearing things that aren’t there) and delusions (believing things that are untrue) low mood or anxiety

Read more about the symptoms of Alzheimer’s disease


The symptoms of Alzheimer’s disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age.

The rate at which the symptoms progress is different for each individual and it’s not possible to predict exactly how quickly it will get worse.

In some cases, infections, medications, strokes or delirium can be responsible for symptoms getting worse. Anyone with Alzheimer’s disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed.

Causes


Alzheimer’s disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas.

It’s not known exactly what causes this process to begin. However, in the brains of people with Alzheimer’s disease, scientists have found amyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine.

It’s also common to have a degree of vascular damage in the brain.

These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them.

Over time, this damage spreads to several areas of the brain. The first areas affected are responsible for memories.

Diagnoses


As the symptoms of Alzheimer’s disease progress slowly, it can be difficult to recognise that there’s a problem. Many people feel that memory problems are simply a part of getting older.

However, a timely diagnosis of Alzheimer’s disease can give you the best chance to prepare and plan for the future, as well as receive any treatment or support that may help.

If you’re worried about your memory or think you may have dementia, it’s a good idea to see your GP. If you’re worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them.

There’s no single test that can be used to diagnose Alzheimer’s disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions.

If Alzheimer’s disease is suspected, you may be referred to a specialist memory service to:

discuss the process of making the diagnosis organise testing  create a treatment plan

Read more about diagnosing Alzheimer’s disease


It’s best to see your GP if you’re worried about your memory or think you may have dementia.

If you’re worried about someone else, encourage them to make an appointment and perhaps suggest going with them. It’s often very helpful having a friend or family member there.

A timely diagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help.


It may take several appointments and tests over months, or even years, before a diagnosis of Alzheimer’s disease can be confirmed.

For some people, a diagnosis of Alzheimer’s disease is a huge shock, especially as it’s not unusual for people with dementia to have less awareness of their difficulties.

For others, the diagnosis can be very important in helping them and their families to make sense of symptoms they’ve been concerned about for a long time.

If you’ve just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talk things through with family and friends.

It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news.

However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future.

Read more about what to do if you’ve just been diagnosed with dementia

Treatments


There’s no cure for Alzheimer’s disease, but medication is available that can help relieve some of the symptoms and slow down the progression of the condition in some people.

Various other types of support are also available to help people with Alzheimer’s live as independently as possible, such as making changes to your home environment so it’s easier to move around and remember daily tasks.

Psychological treatments such as cognitive stimulation therapy may also be offered to help support your memory, problem solving skills and language ability.

Read more about treating Alzheimer’s disease


There’s currently no cure for Alzheimer’s disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people.

Support is also available to help someone with the condition cope with everyday life.


In addition to medication, treatment for Alzheimer’s disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible.

For example, an occupational therapist can identify problems or unsafe areas in your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest:

ways of prompting and reminding yourself of important tasks – such as using diaries or calendars assistive technology – devices or systems to help maintain the independence and safety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community

Psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem solving skills and language ability.

Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimer’s disease.

Read more about how dementia is treated

Preventions


As the exact cause of Alzheimer’s disease isn’t clear, there’s no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as:

stopping smoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active

These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health.

Read more about preventing Alzheimer’s disease


As the exact cause of Alzheimer’s disease is still unknown, there’s no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia.

Anal cancer
of cancer, cancer types in adults



Symptoms of anal cancer can include:

bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence)

However, some people with anal cancer don’t have any symptoms. 

Speak to your GP if you develop any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out.


bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence)

However, some people with anal cancer don’t have any symptoms. 

Speak to your GP if you develop any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out.
Symptoms


The symptoms of anal cancer are often similar to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores).

Symptoms of anal cancer can include:

bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence)

However, some people with anal cancer don’t have any symptoms. 

Speak to your GP if you develop any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out.

Causes


The exact cause of anal cancer is unknown, although a number of factors can increase your risk of developing the condition. These include:

infection with human papilloma virus (HPV) – a common and usually harmless group of viruses spread through sexual contact, which can affect the moist membranes lining your body having anal sex or lots of sexual partners – possibly because this increases your risk of developing HPV having a history of cervical, vaginal or vulval cancer smoking having a weakened immune system – for example, if you have HIV

Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men.

Diagnoses


Your GP will usually ask about your symptoms and carry out some examinations.

They may feel your tummy and carry out a rectal examination. This involves your doctor inserting a gloved finger into your bottom so they can feel any abnormalities. Your GP will refer you to hospital if they think further tests are necessary. 

The National Institute for Health and Care Excellence (NICE) recommends in its 2015 guidelines that GPs should consider referring someone with an unexplained anal lump or anal ulcer. The person should receive an appointment within 2 weeks.

If you’re referred to hospital, a number of different tests may be carried out to check for anal cancer and rule out other conditions.

Some of the tests you may have include a:

sigmoidoscopy – where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities proctoscopy – where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end biopsy – where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope 

If these tests suggest you have anal cancer, you may have some scans to check whether the cancer has spread. Once these are complete, your doctors will be able to ‘stage’ the cancer. This means giving it a score to describe how large it is and how far it has spread.

You can read more about the stages of anal cancer on the Cancer Research UK website.

Treatments


If you’re diagnosed with anal cancer, you’ll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best treatment and care.

The main treatments used for anal cancer are:

chemoradiation – a combination of chemotherapy and radiotherapy surgery – to remove a tumour or a larger section of bowel

In cases where the cancer has spread and can’t be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care.

Chemoradiation

Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (where radiation is used to kill cancer cells). It’s currently the most effective treatment for anal cancer. You don’t usually need to stay in hospital when you’re having chemoradiation.

Chemotherapy for anal cancer is usually given in 2 cycles, each lasting 4 to 5 days, with a 4-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until your treatment has finished.

The tube means you don’t need to stay in hospital during each of the cycles of chemotherapy. However, you’ll be attached to a small plastic pump, which you take home with you.

A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC.

Read more about how chemotherapy is carried out

Radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for 5 to 6 weeks. To prepare for radiotherapy, additional scans will be required.

Read more about how radiotherapy is carried out

Both chemotherapy and radiotherapy often cause significant side effects, including:

tiredness sore skin around the anus sore skin around the penis and scrotum in men or vulva in women hair loss – limited hair loss from the head, but total loss from the pubic area feeling sick diarrhoea

These side effects are usually temporary, but there’s also a risk of longer-term problems, such as infertility. If you’re concerned about the potential side effects of treatment, you should discuss this with your care team before treatment begins. 

Other possible long-term side effects can include:

bowel control problems long-term (chronic) diarrhoea erectile dysfunction vaginal pain when having sex dry and itchy skin around the groin and anus bleeding from the anus, rectum, vagina or bladder

Tell your doctor if you develop any of these symptoms so they can be investigated and treated.

Surgery

Surgery is a less common treatment option for anal cancer. It’s usually only considered if the tumour is small and can be easily removed, or if chemoradiation hasn’t worked.

If the tumour is very small and clearly defined, it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic, that usually only requires a stay in hospital of a few days.

If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic.

An abdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. You’ll usually need to stay in hospital for up to 10 days after this type of surgery.

During the operation, a permanent colostomy will also be formed to allow you to pass stools. This is where a section of the large intestine is diverted through an opening made in the abdomen called a stoma. The stoma is attached to a special pouch that will collect your stools after the operation.

Before and after the operation, you’ll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time.

Read more about living with a colostomy

Follow-up

After your course of treatment ends, you’ll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning.

To start with, these appointments will be every few weeks or months, but they’ll gradually become less frequent over time.

Anaphylaxis
of immune system


Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly.

It is also known as anaphylactic shock.

Signs of anaphylaxis include:

itchy skin or a raised, red skin rash swollen eyes, lips, hands and feet feeling lightheaded or faint swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties wheezing abdominal pain, nausea and vomiting collapse and unconsciousness
Causes


Anaphylaxis is the result of your body’s immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens.

Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4 hours later.

The most widely reported triggers of anaphylaxis are:

insect stings – particularly wasp and bee stings peanuts and tree nuts other types of foods – such as milk and seafood certain medicines – such as antibiotics

Read more about the causes of anaphylaxis.


Anaphylaxis is caused by a problem with the immune system, which is the body’s natural defence against illness and infection.

In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat.

Treatments


If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards.

Call 999 straight away if an adrenaline injector is not available.

If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it.

Preventions


If you know what has triggered anaphylaxis, it’s important to take steps to avoid exposure to similar triggers.

You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future.

You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis.

Read more about preventing anaphylaxis.


If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes.

Angioedema
of skin hair and nails


Angioedema is the swelling of the deeper layers of the skin, caused by a build-up of fluid.

The symptoms of angioedema can affect any part of the body, but swelling usually affects the:

eyes lips genitals hands feet

Many people with angioedema also experience urticaria (hives). This is a raised, red and itchy rash that appears on the skin.

Angioedema can cause swelling in any part of the body, including the lips.Source: https://dermnetnz.org/

Angioedema can cause swelling around the eye.Source: https://dermnetnz.org/
Symptoms


The main sign of angioedema is swelling that develops below the skin’s surface.


As well as visible swellings, angioedema can cause other symptoms, including:

a hot or painful sensation in the swollen areas swelling of the inside of the throat, the windpipe and the tongue, making breathing difficult swelling of the conjunctiva (the transparent layer of cells that cover the white part of the eye), which affects vision

People with hereditary angioedema may also experience:

abdominal (stomach) pain caused by swelling in the stomach and bowel, which can cause nausea, vomiting and diarrhoea swelling of the bladder or urethra (the tube that connects the bladder to the genitals), which can cause bladder problems and difficulty passing urine

Causes


The cause of angioedema depends on the type you have. There are 4 main types of angioedema:

allergic angioedema – the swelling is caused by an allergic reaction, such as a reaction to peanuts, and sometimes occurs in combination with anaphylaxis idiopathic angioedema – there is no known cause for the swelling (although certain factors, such as stress or infection, may trigger the symptoms) drug-induced angioedema – the swelling is a side effect of certain medications, most often angiotensin-converting enzyme (ACE) inhibitors hereditary angioedema – the swelling is caused by “faulty” genes that are inherited from a person’s parents

Read more about the causes of angioedema.


Angioedema is often caused by a problem with the immune system, although there are many cases where no cause can be identified.

Diagnoses


Your doctor can diagnose angioedema by examining the affected skin and discussing symptoms.

However, further tests, such as blood tests or allergy tests, may be required to determine the type of angioedema.

Idiopathic angioedema is only diagnosed if no cause can be found.

Read more about diagnosing angioedema.


Angioedema is usually diagnosed by your doctor examining the affected skin and discussing your symptoms.

It can be difficult to find the exact cause and identify which type of angioedema you have. There is no single test available, but you may have allergy tests or blood tests if a specific cause is suspected.

Treatments


Although most cases of angioedema get better without treatment after a few days, medication is often used.

For cases of allergic and idiopathic angioedema, antihistamines and oral steroids (steroid tablets) can be used to relieve the swelling.

Drug-induced angioedema can usually be treated by using an alternative medication to treat whatever underlying condition you have.

Although the condition cannot be cured, regular drug treatment can prevent attacks in people with hereditary angioedema.

Read more about treating angioedema.


Contact your GP if you have an episode of angioedema that does not affect your breathing and you have not previously been diagnosed with the condition. You will need to have tests to determine what type of angioedema you have.


Dial 999 to request an ambulance if you suspect that you, or someone you know, is experiencing anaphylaxis (a severe allergic reaction). Tell the operator that you suspect anaphylaxis.

Initial symptoms of anaphylaxis include:

a feeling of tightness in the chest that leads to breathing problems  swelling of the tongue and throat

If you, or the person in your care, has previously been prescribed an adrenaline auto-injector pen, you should use it while waiting for the ambulance to arrive.


Medication is the main treatment for angioedema, although many cases get better after a few days without treatment.

Allergic angioedema and idiopathic angioedema are usually treated in the same way, using a combination of antihistamines and corticosteroids to help relieve the swelling.

Drug-induced angioedema can usually be treated by using an alternative medication to the one causing your symptoms.

If you also had symptoms of anaphylaxis during an episode of angioedema, you will probably be given an adrenaline auto-injector pen in case your symptoms return. 

Read more about treating anaphylaxis.

Hereditary angioedema cannot be cured and does not respond to adrenaline, antihistamines or steroids, so a preventative approach is taken. A number of different medications are used to stabilise the protein levels in your blood to help prevent symptoms developing.

Ankylosing spondylitis
of muscle bone and joints, conditions


Ankylosing spondylitis (AS) is a long-term (chronic) condition in which the spine and other areas of the body become inflamed.

The symptoms of AS can vary but usually involve:

back pain and stiffness that improves with exercise and isn’t relieved by rest pain and swelling in other parts of the body, such as the hips, knees and ribs fatigue (extreme tiredness)

These symptoms tend to develop gradually, usually over several months or years, and may come and go over time.

In some people, the condition gets better with time, but for others it can get slowly worse.

Read more about the symptoms of ankylosing spondylitis 
Symptoms


The symptoms of ankylosing spondylitis (AS) can vary from person to person, but usually develop slowly, over several months or years.

AS usually first starts to develop during later teenage years or early adulthood. The symptoms may come and go, and improve or get worse over many years.


The main symptoms of AS are described below, although you may not develop all of these if you have the condition. 

Back pain and stiffness

Back pain and stiffness are usually the main symptoms of AS. You may find:

the pain gets better with exercise but doesn’t improve, or gets worse, with rest the pain and stiffness is worse in the morning and at night – you may wake up regularly during the night because of the pain you have pain in the area around your buttocks

Arthritis

As well as causing symptoms in your back and spine, AS can also cause inflammation of the joints (arthritis) in other parts of your body, such as your hips and knees. The main symptoms associated with arthritis are:

pain on moving the affected joint tenderness when the affected joint is examined swelling and warmth in the affected area  

Enthesitis

Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones).

Common sites for enthesitis are:

at the top of the shin bone behind the heel (Achilles tendon) under the heel where the ribs join to the breast bone

If your ribs are affected, you may experience chest pain, and you may find it difficult to expand your chest when breathing deeply.

Fatigue

Fatigue is a common symptom of untreated AS. It can make you feel tired and lacking in energy.

Causes


In AS, various areas of the spine and other joints become inflamed.

As well as causing pain, stiffness and swelling, this inflammation can damage affected areas of the body over time, and in some cases can lead to some of the individual bones of the spine fusing (joining together). This fusing of the spine is known as ankylosis.

It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27.

Read more about the causes of ankylosing spondylitis.


In ankylosing spondylitis (AS), several parts of the lower spine become inflamed, including the vertebrae (bones in the spine) and spinal joints.

Over time, this can damage the spine and lead to the growth of new bone, which in some cases can cause parts of the spine to join up (fuse) and lose flexibility. This is known as ankylosis.

It is not known exactly what causes AS, but in many cases there seems to be a link with a particular gene known as HLA-B27.

Diagnoses


Ankylosing spondylitis (AS) can be difficult to diagnose because the condition develops slowly and there is no definitive test to confirm a diagnosis.

The first thing you should do if you think you have AS is to see your GP. They will ask about your symptoms, including what symptoms you are experiencing, when they started and how long you have had them.

Back pain associated with AS can be quite distinctive. For example, it usually doesn’t improve with rest and may wake you up during the night.


If your GP suspects AS, they may arrange blood tests to check for signs of inflammation in your body. Inflammation in your spine and joints is one of the main symptoms of the condition.

If your results suggest you do have inflammation, you will be referred to a rheumatologist for further tests. A rheumatologist is a specialist in conditions that affect muscles and joints.


Your rheumatologist will carry out imaging tests to examine the appearance of your spine and pelvis, as well as further blood tests. These are described below.

X-rays

An X-ray of your lower back can show damage to the joints at the base of your spine (the sacroiliac joints) and new bone forming between the vertebrae (bones in your spine), which are common signs of advanced AS.

MRI scan

A magnetic resonance imaging (MRI) scan may highlight changes in your sacroiliac joints that might not show up on an X-ray. It may also show any inflammation of ligaments in the spinal region.

Ultrasound scan

An ultrasound scan can pick up inflammation of the tissues (tendons and ligaments) attached to your bones.

Genetic testing

A genetic blood test may sometimes be carried out to see if you carry the HLA-B27 gene, which is found in most people with AS.

This can contribute towards a diagnosis of AS, but it is not entirely reliable as not everyone with the condition has this gene, and some people have the gene without ever developing AS.

Treatments


You should see your GP if you have persistent symptoms of AS.

If your GP thinks you may have the condition, they should refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment.

Read more about diagnosing ankylosing spondylitis.


There is no cure for AS and it is not possible to reverse the damage caused by the condition. However, treatment is available to relieve the symptoms and help prevent or delay its progression.

In most cases, treatment will involve a combination of:

exercises carried out individually or in groups to reduce pain and stiffness physiotherapy – where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility medication to help relieve pain and reduce inflammation – such as painkillers and a type of medicine called anti-TNF medication

Surgery is sometimes needed to repair significantly damaged joints or correct severe bends in the spine, but this is uncommon.

Read more about treating ankylosing spondylitis.


You should see your GP if you have persistent symptoms of AS.

If your GP thinks you may have the condition, they should refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment.

Read more about diagnosing ankylosing spondylitis.


There is no cure for ankylosing spondylitis (AS), but treatment is available to help relieve the symptoms.

Treatment can also help delay or prevent the process of the spine fusing (joining up) and stiffening.

In most cases, treatment will involve a combination of exercise, physiotherapy and medication, which are described below.

Complications


Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life and lead to additional health conditions.

Some complications associated with AS are outlined below.

Anorexia nervosa
of mental health


People who have anorexia are very anxious about their weight and body shape. They try to keep their weight as low as possible by strictly controlling what they eat. Many people with anorexia will also exercise excessively.

They may also use other methods to try to control their weight, like using laxatives, vomiting after eating, and taking stimulant drugs.


They may also use other methods to try to control their weight, like using laxatives, vomiting after eating, and taking stimulant drugs.

Symptoms


Signs and symptoms of anorexia include:

fear of ‘being fat’ or gaining weight problems with self-esteem and body image when it comes to food and weight restricting food intake keeping your body weight low, to the point it’s unhealthy

Restricting your food intake means your body isn’t getting enough energy or nutrition. This can lead to other physical symptoms.

Other signs of anorexia

Eating too little for a long time can cause physical symptoms, like:

fine downy hair (lanugo) growing on the body more hair on the face pubic hair becoming sparse and thin slow or irregular heartbeat

People with anorexia may also:

have pain in their abdomen (tummy) feel bloated or constipated have swelling in their feet, hands or face feel very tired have low blood pressure (hypotension) feel cold or have a low body temperature feel light-headed or dizzy

In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected for someone going through puberty. They might be shorter than other people of the same age.

If you get periods and you have anorexia, your periods may stop. Anorexia can also lead to infertility, for both men and women.

Diagnoses


When making a diagnosis, your GP will probably ask questions about your weight and eating habits.

For example, they might:

ask if you’ve lost a lot of weight recently or quite quickly ask how you feel about your weight, and if you’re concerned about it ask if you make yourself vomit regularly check if you have periods, whether your periods have stopped and if so, for how long check your weight check your pulse and blood pressure do a blood test

It’s important to answer these questions honestly. Your GP isn’t trying to judge you. They just need to accurately assess your symptoms.

Referral to a specialist

If your GP thinks you may have anorexia, they’ll refer you to a specialist in eating disorders for a more detailed assessment. Your GP sometimes carries out this assessment.

Treatments


Treatment for anorexia usually involves a combination of:

talking therapy, and supervised weight gain

It’s important to start treatment as early as possible to reduce the risk of serious complications.

Treatment for anorexia is slightly different for adults and those under 18 years old.

Complications


If someone has anorexia for a long time, it can lead to severe complications and health problems. These can sometimes be permanent.

People with anorexia have an increased risk of:

poor circulation and cardiovascular problems heart conditions, like coronary heart disease and irregular heartbeat (arrhythmia) health problems caused by malnutrition – a lack of vitamins and minerals

Anorexia can cause an imbalance of minerals in the blood, like potassium, calcium and sodium. These minerals help keep you healthy. When there’s an imbalance, it can cause symptoms like:

tiredness weakness dehydration fits irregular heartbeat (arrhythmia) muscle spasms confusion

Health conditions

Other conditions that can be caused by anorexia and malnutrition can include:

low blood pressure (hypotension) anaemia dental problems, like tooth decay caused by regular vomiting low blood sugar levels (hypoglycaemia) acute kidney (renal) failure liver damage heart failure osteoporosis (fragile bones) and loss of muscle strength, particularly in women and girls loss of sex drive (libido) and impotency in men

Misuse of laxatives can damage the bowels and cause permanent constipation.

Anorexia and pregnancy

Anorexia can lead to irregular menstrual cycles (periods), or cause your periods to stop altogether. This doesn’t mean anorexia makes you infertile.

If you have anorexia, even if your periods are irregular or have stopped, you should continue to use birth control if you aren’t planning a pregnancy.

If you have anorexia and are trying to become pregnant, you should discuss this with your GP and care team.

Anorexia during pregnancy can increase the risk of complications, like:

miscarriage giving birth early (premature birth) having a baby with a low birth weight

You’re also likely to need extra care and support during pregnancy if you have previously had anorexia and recovered from it.



Users in supermaster role can add new disease entries