Ankylosing Spondylitis

Question 1

What is Ankylosing spondylitis?

Answer 1

Inflammatory condition mainly affecting spine

-Causes progressive stiffness and pain

Question 2

Which group of conditions is ankylosing spondylitis part of?

Answer 2

Spondyloarthropathy

Question 3

What gene is anklysoing spodylitis related to?

Answer 3

HLA B27 gene

Question 4

Who gets anklyosing spondylitis

Answer 4

• 90% of patients with the HLA B27 gene
• Males
• Late teens/20s

Question 5

Where do you get ankylosing spondylitis?

Answer 5

Sacroiliac joints

Vertebral column

Question 6

Presentation of ankylosing spondylitis?

Answer 6

• Develops gradually over more than 3 months
• Lower back pain and stiffness
• Sacroiliac pain in buttock
• Pain worse with REST & improves with movement
• Pain worse at night & morning- lasts for under 30 minutes

Question 7

Key complication of AS?

Answer 7

Vertebral fractures

Question 8

Other symptoms of AS?

Answer 8

• Systemic (wt loss/fever)
• Chest pain
• Enthesitis (plantar fasciitis & Achilles tendonitis)
• Dactylitis
• Anaemia
• Anterior uveitis
• Aortitis
• Heart block
• Restrictive lung disease
• IBD

Question 9

Investigations of AS?

Answer 9

• Inflammatory markers (ESR & CRP)
• HLA B27 genetic test
• Schober’s test
• X-ray of spine
• MRI of spine

Question 10

What is Schober’s test?

Answer 10

Test where patient must stand straight and you find L5 vertebrae, mark point 10cm above & 5cm below
Ask patient to bend forward far as they can and if the distance is less than 20cm this indicated lumbar restriction

Question 11

Signs on x-ray?

Answer 11

• Bamboo spine
• Squaring of vertebral bodies
• Subchondral sclerosis/erosions
• Ossification
• Fusion of facet, sacroiliac & costovertebral joints
• Syndesmophytes

Question 12

Management of AS with meds?

Answer 12

• NSAIDs (pain)
• Steroids (for symptom flares)
• Anti-TNF
• Secukinumab (Monoclonal ABs)