Ankylosing spondylitis

Question 1

What is ankylosis spondylitis?

Answer 1

It is seronegative chronic inflammatory joints which is mainly affect primarily spine and sacroiliac joints and secondary hip,shoulder,knee

Question 2

what gene present in As?

Answer 2

HLA B27

Question 3

Who are more common affected?

Age?

Answer 3

Young adults

Age:15-20

Question 4

Causes?

Answer 4

Unknown

Question 5

Presentation?

Answer 5

Young male
age:15-20
male >female

lower back pain and stiffness and sacroiliac pain in the buttock region.

The pain and stiffness is worse with rest and improves with movement. The pain is worse at night and in the morning and may wake them from sleep. It takes at least 30 minutes for the stiffness to improve in the morning and it gets progressively better with activity throughout the day.

Symptoms can fluctuate with “flares” of worsening symptoms and other periods where symptoms improve.

Vertebral fractures are a key complication of AS.

Associations

Ankylosing spondylitis does not only affect the spine. It can affect other organ systems causing:

Systemic symptoms such as weight loss and fatigue
Chest pain related to costovertebral and costosternal joints
Enthesitis is inflammation of the entheses. This is where tendons or ligaments insert in to bone. This can cause problems such as plantar fasciitis and achilles tendonitis.
Dactylitis is inflammation in a finger or toe.
Anaemia
Anterior uveitis
Aortitis is inflammation of the aorta
Heart block can be caused by fibrosis of the heart’s conductive system
Restrictive lung disease can be caused by restricted chest wall movement
Pulmonary fibrosis at the upper lobes of the lungs occurs in around 1% of AS patients
Inflammatory bowel disease is a condition associated with AS

Question 6

what is schober test?

Answer 6

This is a test used as part of a general examination of the spine to assess how much mobility there is in the spine. You might be asked to do it in your OSCE examinations.

Have the patient stand straight. Find the L5 vertebrae. Mark a point 10cm above and 5cm below this point (15cm apart from each other). Then ask the patient to bend forward as far as they can and measure the distance between the points.

If the distance with them bending forwards is less than 20cm, this indicates a restriction in lumbar movement and will help support a diagnosis of ankylosing spondylitis.

Question 7

investigation?

Answer 7

Investigations

Inflammatory markers (CRP and ESR) may rise with disease activity
HLA B27 genetic test
Xray of the spine and sacrum
MRI of the spine can show bone marrow oedema early in the disease before there are any xray changes

Xray Changes

“Bamboo spine” is the typical exam description of the xray appearance of the spine in later stage ankylosing spondylitis. This is worth remembering for your exams.

Xray images in ankylosing spondylitis can show:

Squaring of the vertebral bodies
Subchondral sclerosis and erosions
Syndesmophytes are areas of bone growth where the ligaments insert into the bone. They occur related to the ligaments supporting the intervertebral joints.
Ossification of the ligaments, discs and joints. This is where these structures turn to bone.
Fusion of the facet, sacroiliac and costovertebral joints