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4: Y4 - Rheumatology [19] > [4] Ankylosing Spondylitis TO REDO > Flashcards

[4] Ankylosing Spondylitis TO REDO Flashcards

1
Q

What is ankylosing spondylitis?

A

Ankylosing spondylitis is a type of arthritis in which there is long term inflammation of the joints of the spine.

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2
Q

What joints, other than the spine, are affected in anylosing spondylitis?

A

Typically, where the spine joins the pelvis is affected

Occassionally, other joints such as the shoulder and hips are involved

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3
Q

What problems, other than joint problems, might occur with ankylosing spondylitis?

A

Eye and bowel problems

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4
Q

What causes ankylosing spondylitis?

A

The exact cause is unknown, but it is believed to involve a combination of genetic and environmental factorrs

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5
Q

What gene is implicated in ankylosing spondylitis?

A

The HLA-B27 gene

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6
Q

What % of people with ankylosing spondylitis have the HLA-B27 gene?

A

More than 90%

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7
Q

What is the underlying mechanism of disease in ankylosing spondylitis?

A

Autoimmune or autoinflammatory

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8
Q

Describe the onset of symptoms in ankylosing spondylitis?

A

Symptoms usually develop slowly over several months or years

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9
Q

What happens to the symptoms of ankylosing spondylitis over time?

A

They may come and go, improve, or get worse

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10
Q

What are the main symptoms of ankylosing spondylitis?

A
  • Back pain and stiffness
  • Arthritis
    Enthesitis
  • Fatigue
    *
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11
Q

What are the features of the back pain and stiffness in ankylosing spondylitis?

A
  • The pain gets better with exercise, but doesn’t improve or get worse with rest
  • The pain and stiffness is worse in the morning and at night, and may wake the patient from sleep
  • The pain may be present in the area around the buttocks
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12
Q

What is enthesitis?

A

Painful inflammation where a bone joins to a tendon or a ligament

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13
Q

What are the common sites for enthesitis in ankylosing spondylitis?

A
  • Proximal tibia
  • Achilles tendon
  • Under heel
  • Sternocostal joints
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14
Q

What symptoms might be present if the sternocostal joints are involved in ankylosing spondylitis?

A
  • Chest pain
  • Difficulty fully expanding the chest
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15
Q

What is treatment aimed at in ankylosing spondylitis?

A

Symptomatic relief and delaying progression of the disease

There is no cure

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16
Q

What are the options in the management of ankylosing spondylitis?

A
  • Exercise and physiotherapy
  • Painkillers
  • Other medications
  • Surgery
17
Q

What are the types of physiotherapy and exercise available in the management of ankylosing spondylitis?

A
  • Group exercise programmes
  • Individual exercise programmes
  • Massage
  • Hydrotherapy
18
Q

What medications are used in the management of ankylosing spondylitis?

A
  • Painkillers
  • Anti-TNF medication
  • Corticosteroids
  • DMARDs
19
Q

What painkillers are used in the management of ankylosing spondylitis?

A
  • NSAIDs, such as ibuprofen, naproxen, and diclofenac
  • Paracetamol
  • Codeine
20
Q

What are the criteria for the use of anti-TNF medicatin in the management of ankylosing spondylitis?

A
  • Confirmed diagnosis of ankylosing spondylitis
  • Patients level of pain assessed twice, 12 weeks apart, and condition has not improved
  • Bath Ankylosing Spondylitis Disease Activity Index tested twice, at least 12 weeks apart, and confirms the condition has not improved
  • Treatment with two or more NSAIDs for 4 weeks at the highest possible dose has not controlled symptoms
21
Q

What happens after 12 weeks of anti-TNF medication?

A

Pain score and BASDAI are tested again to see if they’ve improved enough to make continuing treatment worthwhile. If they have, treatment will continue and testing is done every 12 weeks

22
Q

How are corticosteroids administered in ankylosing spondylitis?

A

They can be taken orally, or injected by the patient

If a particular joint is inflamed, they can be injected directly into the joint

23
Q

How many injections can be given into one joint in a year?

A

Not usually more than 3

24
Q

Why can a patient not usually have more than 3 corticosteroid injections into the joint in one year?

A

As they can cause a number of side effects,

25
Q

What are the side effects of corticosteroid injections into the joint?

A
  • Infection
  • Depigmentation
  • Atrophy
  • Tendon rupture

4: Y4 - Rheumatology [19] (10 decks)

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