Marie-strümpell spondylitis in women.

A form of chronic arthritis of the spine characterized by certain distinguishing features was described by Marie (1898), Strumpell (1897), and von Bechterew (1899), at the turn of the 19th century. It is not an uncommon disease, but is very often unrecognized and from time to time articles appear in the medical literature calling attention to its importance in the differential diagnosis of low back and sciatic pain. In all of these articles, it is generally agreed that the disease is much more common in males than in females, the stated ratio varying from 4: 1 (Simpson and Stevenson, 1949) to 10: 1 (West, 1948). It is usually assumed that the disease runs a similar course in both sexes, and this investigation was undertaken in order to study this feature. It occurred to us that there might be differences in the clinical manifestations and course of the disease which made the difference in sex distribution more apparent than real. In the male we usually find an onset in early adult life with persistent, though at times relenting, progression. The severe systemic effects of the disease are chiefly characterized by loss of weight and strength, extensive muscle atrophy, and a marked tendency to forward-flexion deformity of the spine. The pallor of chronic disease is present in most cases, but is often not correlated with the blood picture. The pain of ankylosing spondylitis is its most prominent feature, and it is often paradoxical in that, though the pain is severe, it cannot be accurately located or described by the patient. Its most characteristic feature is that of being at its worst in the early hours of the morning or following any prolonged period of rest. The extensive ankylosing features are marked in males, and eventually lead to fixation of the spine and its adjacent articulations. The end-result is a pathetic picture of a thin, chronically ill, discouraged man standing stooped over with flexed hips and knees, and arms and head hanging forward. Material of Present Study