Ankylosing Spondylitis

Question 1

what is ankylosing spondylitis?

Answer 1

inflammatory condition
mainly effects the spine
part of the seronegative spondyloarthropathies (HLA-B27 gene)

Question 2

seronegative spondyloarthropathies

Answer 2

• ankylosing spondylitis
• reactive arthritis
• psoriatic arthritis

Question 3

symptoms / signs of ankylosing spondyltiis

Answer 3

progressive stiffness
pain
commonly effects the sacroiliac joints and the joints of the vertebral column

can progress to fusion of the spine and sacroiliac joints “bamboo spine”

young adult (male) late teens / 20s

lower back stiffness
sacroiliac pain in buttock region
worse with rest 
improves with movements
worse at night and int he morning
>30 morning stiffness

can have flares
complication- vertebral fractures

Question 4

associations of AS

Answer 4

can affect other organ systems:

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 5

what is the Schober’s test?

Answer 5

examination of spine
fine L5 and mark 10cm above and 5cm below this point (15cm)

ask patient to bend forward and measure the distance between the points

if distance is <20cm this indicates a restriction in lumbar movement and supports a diagnosis of AS

Question 6

what are the investigations for AS?

Answer 6

Inflammatory markers (CRP and ESR) may rise with disease activity

HLA B27 genetic test

Xray of the spine and sacrum (bamboo spine)

MRI of the spine can show bone marrow oedema early in the disease before there are any xray changes

Question 7

Xray changes of AS

Answer 7

bambo spine
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

Question 8

what is the management for AS?

Answer 8

conservative: physiotherapy, exercise and mobilisation, avoid smoking

medical:
NSAIDs (discontinue/switch if no improvement after 2-4 of maximum dose)
steroids (flares)
anti TNF (etanercept)
monoclonal antibody against TNF - infliximab, adalimumab
secukinuab

*bisphosphonate to treat osteoperosis

surgical:
if deformity to the spine or other joints

Question 9

psoriasis

Answer 9

scalp
nasal cleft
extensor surfaces
umbilicus