Directions: After completing the rapid reading exercise below, read the article on ankylosing spondylitis, and answer the ques

Directions

After completing the rapid reading exercise below, read the article on ankylosing spondylitis, and answer the questions that follow the reading passage.

Rapid Reading Warm-Up

Directions: The exercise below has 25 problems that will help you read faster. You will have only 30 seconds to finish. You will probably not finish all 25 problems, but you are to work as quickly as you can. Be careful not to make any error, so read rapidly but carefully. In this exercise, there are six words: one word to the left of the line and five to the right. Read the word on the left and then find it among the five words to the right.

Example

raft	rift	rate	raft	rote	reef
stiff	strife	still	stiff	staff	safe
chronic	chrome	chronic	crone	clone	cosmic
joints	joins	jaunts	joint	javelin	joints
results	resorts	resents	reports	resorts	results
present	pleasant	preset	presents	predicts	present
hips	hypes	hops	hips	hoops	hopes
pain	pane	plain	pain	plow	pain
back	back	block	black	book	broke
more	morel	more	mare	mire	moor
diagnosis	diagonal	diagnoses	diagnosis	dragons	dragoons
treat	treats	trite	treat	trot	tripe
feature	future	fracture	feature	fortunate	featured
tissue	issue	ensure	tissues	tints	tissue
genes	glens	greets	genes	grows	greens
better	bitter	bottle	batter	butter	better
inject	insert	incant	intent	inject	instant
heels	holes	heels	heals	helps	heists
disability	disable	ability	disabilities	disability	disabled
inflame	inflames	inflamed	income	frame	inflame
steroid	stereo	steered	steamed	steroid	steroids
severe	seven	stevedore	sever	severe	severs
hormone	hormonal	harmony	horror	harmonica	hormone
weakens	weaken	weaker	weakens	weakness	weakened
feeling	feeding	failing	fooling	freeing	feeling
manage	manage	merger	managed	manager	manages

Reading

Ankylosing spondylitis (AS) is a chronic inflammatory form of arthritis that affects the spinal joints. The hallmark of AS is the involvement of the sacroiliac (SI) joints, the joints at the base of the spine where the spine joins the pelvis. AS is three times more common in men than in women. It typically affects young people, beginning between the ages of 15 and 40. It may affect younger people also although in very young people it may take a slightly different form, causing pain around the heels, knees, and hips rather than beginning with the spine. Onset after age 40 is uncommon.

The exact cause of AS is unknown. AS tends to run in families. Just as people inherit their hair color and blood type from their parents, they also inherit their tissue type. The tissue typing system is the human lymphocyte antigen (HLA) system. One of the tissue types, HLA-B27, is found in only 6% of the broad population but occurs in approximately 93% of individuals with AS. The HLA-B27 tissue type, while not causing AS, does predispose individuals with the B27 tissue type to develop AS. Thus, AS tends to occur in families. Having the tissue type itself does not mean that an individual will develop AS; it simply increases the possibility. Identifying the activating agent that later triggers AS is the focus of much current research.

There are definite warning signs of AS. The most universal symptom is chronic low back pain that seems to come on for no apparent reason. The pain is typically worse in the morning. On rising from bed, people with AS may feel stiff and sore, and it may take anywhere from 30 minutes to several hours to pass off. The back pain is usually dull and diffuse rather than sharp and localized. The most common site of pain is deep within the buttock, on one side or on both sides. In addition to the buttock, there could be pain further up the back, perhaps between the shoulder blades or in the neck. In a lesser number of individuals, pain does not begin in the spine but starts in a hip, knee, or shoulder joint. This can be confusing when there is no back pain present and may initially look like some other form of arthritis.

The pain of AS results from inflammation of the joints. When inflammation is present, the involved area hurts. To avoid the pain, there is a natural tendency to stoop forward, as extending backwards is more uncomfortable. This reflex can lead to bad posture. Also, in bed there is a tendency to curl up, as this may feel more comfortable.

If the inflammation associated with AS continues unchecked, it can produce changes within the spinal column. Small bony outgrowths extend from the edges of the vertebrae and can eventually bridge across from one vertebra to the next. Should this occur, over time it can result in stiffness and immobility between the vertebrae. While there are 24 different spinal vertebrae in the back, stiffness of any two of the 24 can limit function. Stiffness of more can lead to progressive disability.

While spinal stiffness is to be avoided, even greater potential disability can occur if AS affects the hips, knees, or shoulders. The hip joints are quite often involved and can progress to where the joint is damaged, becoming limited in mobility and painful. The end stage of this hip damage is frequently total hip joint replacement.

AS does not affect just the joints. It can also lead to complications. Individual with AS have a much greater likelihood of having episodes of iritis, inflammation of the iris of the eye. This results in the eye being painful and irritated. It is often described as a feeling of having a handful of sand thrown in the eye. The individual may also be sensitive to bright light. This is usually treated with eye drops. Furthermore, although it is relatively uncommon, there is a possibility of inflammation involving the aorta near the heart. If individuals have AS, their physicians may, therefore, listen to their hearts from time to time.

Diagnosis is made from several different features. The history of the onset of pain, the areas of involvement, and the times of the day when pain is worst are key. In young people the presence of tender points at specific locations around the feet, heels, knees, and hips can be indicative of AS. Since AS often affects young, active males, it is sometimes misdiagnosed as mechanical low back strain.

At this time, there is no cure for AS. Therefore, treatment is designed to minimize pain and to maintain mobility and function. Establishing the correct diagnosis early is important because the sooner appropriate treatment is started the better the chance of avoiding disability or deformity. The most common type of medicine used to treat AS is nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers, and bleeding. For those with severe disease who have inflamed joints, a drug called sulfasalazine can help manage the symptoms and better control the disease. Sulfasalazine is one type of a family of medicines called disease-modifying anti-rheumatic drugs (DMARDs). DMARDs try to stop AS from getting worse. DMARDs take about two to six months before they begin to make a difference in the pain and swelling. However, DMARDs may lead to side effects such as mouth sores, diarrhea, and nausea. For severe pain and inflammation, doctors use a third type of medicine. Doctors can inject a corticosteroid directly into the affected joint. Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone. An injection can provide almost immediate relief for a tender, swollen, and inflamed joint. However, this treatment can only be used rarely since corticosteroids can weaken the cartilage and remove minerals from the bone, resulting in further joint weakness.

Finally, along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage their arthritis gives them a greater feeling of control and a more positive outlook. To get the best results, people affected by AS need to form close ties with their doctors and therapists and become full partners in their treatment.

1. What is the thesis of the article?

a. Ankylosing spondylitis is a form of arthritis that affects the spinal joints.

b. Ankylosing spondylitis has several features.

c. Ankylosing spondylitis can be defined according to its major aspects.

2. Based on the reading, who is more likely to develop AS?

a. a female adolescent aged 15

b. a male adolescent aged 19

c. an adult male aged 41

3. What is the main idea of paragraph 2 ?

a. Scientists do not know what causes AS.

b. HLA-B27 causes AS.

c. AS may have a genetic basis.