1.3 Ankylosing Spondylitis

Question 1

List Drugs available to treat AS

Relevance to Anaesthesia

Answer 1

1 - NSAIDs

2- DMARDs

Question 2

NSAIDs in AS -

Uses

Side effects / relevance to Anaesthesia

Answer 2

Anti inflammatory purposes / symptom relief

GI:
Ulcer / bleeding
Resus + RSI

Impair Plt function:
Increase periop bleeding
regional technique

Renal:
Choice drugs
inhib plt

CVS disease - PgI2 inhib
increase risk periop Adverse event

Question 3

DMARDs

Answer 3

Sypmtom relief on joints

MTX
Pulmonary toxicity
cirrhosis
blood dyscrasia

Sulfasalazine
Gi Sy
Haematological toxicity

Leflunomide
Gi Symp
HTN
arryhthmia

Steroids
HTN
Osteoporosis
GI symp
pancreatitis
obesity
pysch

Question 4

Immunomodulators -

How work

Types x 2
examples

SE

Answer 4

MOA Anti TNF Alpha

Cytokine based drugs

_________________________

1. MAB
2. Fusion protein -

alter inflammation or infection responses

infliximab / adalimumab / enteracept

___________________________

General S/E
Immunosuppression - *TB - pre screen

Reactivation chronic hep b

injection site and infusion rxn

autoimmune neur disease - GBS

Question 5

Clincal features important for Anaes of AS

Answer 5

1 Airway

2 Skeletal deformities

3 Regional anaesthesia

4 Extra articular
i - CVS
ii Resp
iii Other

Question 6

Airway - AS

Answer 6

1 Potential Difficult
C spine + TMJ involved

2 Risk:
a Atlanto axial subluxation
b Neuro damage
c Vertebro basilar insufficiency -

important during instrumentation + transfer - manual in line stabilisation

Vocal cord risk - damage fixation crico arytenoid

AFOI or use adjuncts

Question 7

Skeletal deformities

Answer 7

Chin on chest flexion deformity - complicat airway

increase risk of spinal # from minimal trauma
care trasferring

Flexion deformities / scoliosis
position on table difficult - sores / nerve injuries

Question 8

Regional Anaesthesia

Answer 8

Difficult / impossible - bony fusion / spinal involvement

Risk epidural haematoma - narrow canal + nsaids

Intrathecal via paramedian - may be only option

Question 9

CVS

Answer 9

Increase risk AR, MI & conduction defects - arrhythmia

Preop ecg mandatory - consider echo

Preinduction invasive monitoring if dysfunction

Question 10

Resp

Answer 10

Restrictive patten:

pulmonary fibrosis
+
Costovertebral joint involvement

Preop abg +- PFTs
post op hdu icu

Question 11

Other

Answer 11

Anteror uveitis - eye care

amyloid - renal impairment U+E

cauda equina cord compression
epilepsy