ankylosing arthiritis Flashcards
What is ankylosing spondylitis?
Abnormal stiffening of joints (sacroiliac + vertebral) due to new bony formation
- seronegative
- HLA B27
Typical patient presentation of Ankylosing spondylitis? (3)
Young male with progressively worsening back stiffness
- symptoms >3 months
- can also have pain in bum from sacroiliac
- Worse in morning/night
- Better with exercise
- >30 mins morning stiffness
Symptoms of Ankylosing Spondylitis? (6)
- anterior uveitis
- enthesitis
- dactylitis - inflammation of digits
- Lumbar pathology:
- decreased in natural lumbar lordosis
- Schober test shows decreased lumbar flexion (<20cm)
Treatment for Ankylosing Spondylitis? (3)
exersize
NSAIDS
(steroid injection if severe)
DMARD (improve disease) = TNF alpha blockers (Infliximab (mAB) or Etanercept)
MUST STATE TNF INHIBITORS
severe kyphosis or lordosis
kyphosis
sequency of structural damage in ankylosing spondilitis
- inflammation
- fat formation - erosive damage repair
- new bone formation
sacroiliac findings on mri
acute sacroiliitis = bone marrow oedema
usually on L side
Risk factors for ankylosing spondylitis? (2)
young males
HLA B27 +ve
Pathophysiology of ankylosing spondylitis? (2)
Syndesmophytes (vertical abnormal bony growth) replace spinal bone damaged by inflammation + makes spine much less mobile
- also causes inflamed tendons, eye, fingers
HLA B27
mri or xray
mri always
main xray features causing bamboo spine
Syndesmophytes
Sacroiliitis – joint fusion
main effective treatment
TNFi
Last resort for ankylosing spondylitis?
Surgery
Investigations to diagnose ankylosing spondylitis? (4)
X-Ray = bamboo spine + sacroiliitis + squared vertebral bodies + syndesmphytes (fusion of vertebral bodies
MRI -> can show sacroiliitis before X-ray therefore better screening tool
Schober Test -> Decreased lumbar flexion
ESR and CRP will be raised and
genetic testing - can be HLA-B27 +ve
features on xray
- bamboo spine
- squaring of vertebral bodies
- subchondral erosions
- ossification
- syndesmoorphytes - where ligaments insert to bone
Features of inflammatory back pain in ankylosing spondyloarthritis? (4)
Inflammatory back pain which:
- starts under 40yrs of age
- wake up at night with back pain that improves with movement
- improvement with exercise
- insidious onset
classification for diagnosing axial spondylarthiritis
ASAS classification criteria (SpA)
either
sacroilitis on imagine + > SpA feature
OR
HLA-B27 + > 2 other SpA feature
Enthesitis
Enthesitis is inflammation of the entheses, the sites where tendons, ligaments and joint capsules attach to bones
commonly Achilles tendinitis
