Ank Spond

Question 1

What sort of arthritis is ank spond?

Answer 1

Seronegative spondyloarthropathy

Question 2

What does ank spond involve?

Answer 2

Inflammatory arthritis of the axial skeleton and associated extra-articular features

Question 3

What would you see on spine exam of ank spond?

Answer 3

Question mark - increased thoracic kyphosis, diminished lumbar lordosis
Sacroiliac joint tenderness
Restriction of lumbar flexion with schober’s test
Reduced lateral flexion
Reduced chest expansion

Question 4

Risk factors + epidemiology of ank spond

Answer 4

HLA-B27 allele (positive in > 95%)
Age 20-30
Male
Positive FH

Question 5

Describe the low back pain seen in ank spond

Answer 5

Progressive
Relieved by exercise
Night pain - improves on getting up
Radiates to sacroiliac joints (sacroiliitis) and hips

Question 6

Associated features of ank spond

Answer 6

Morning stiffness 
Fever
Weight loss
Fatigue
Peripheral arthritis

Question 7

Extra-articular features of ank spond

Answer 7

Anterior uveitis
Aortitis, aortic regurgitation + AVN block
Apical fibrosis
Amyloidosis -> glomerulonephritis
Achilles tendonitis
Cauda equina

Question 8

ank spond investigations

Answer 8

Clinical diagnosis
X-ray (partic SI joints; may be normal in early disease)
MRI - more sensitive than xray
FBC - anaemia
ESR + CRP - raised (but normal doesn’t exclude)
(HLA-B27 +ve in 90% but also in 10% normal people)

Question 9

Management of ank spond

Answer 9

Exercise + physio - eg swimming
NSAIDs + PPI if long-term - may need to try 2 or more
TNF-a inhibitors (eg etanercept) - if 2 or more NSAIDs fail
Steroid injections + short courses - for flare ups?
DMARDs only useful if peripheral joint involvement

Question 10

X-ray of ank spond

Answer 10

Sacroiliitis - loss of joint space, sclerosis, subchondral erosions at SI joints. sclerosis of joint margins is asymmetrical at early stage but symmetrical + bilateral at late
Squaring of lumbar vertebral bodies
Bamboo spine - vertebral body fusion - late + uncommon
Chest - apical fibrosis
Syndesmophytes - ossification of annulus fibrosis - white discs?