Ankylosing spondylitis

Question 1

Ankylosing Spondylitis

Answer 1

Chronic disease of unknown aetiology characterised by
stiffening and inflammation of the spine and sacroiliac
joints causing fusion

Question 2

Epidemiology of ankylosing spondylitis

Answer 2

M>F=6:1
Men present earlier – late teens, early 20s
Genetics: 95% are HLA-B27+ve

Question 3

Presentation

Answer 3

• Gradual onset back pain
• Radiates from SI joints to hips and buttocks
• Worse at night with morning stiffness
• Relieved by exercise.
• Progressive loss of all spinal movements
• Schober’s test <5cm
• Some develop thoracic kyphosis
• Enthesitis: Achilles tendonitis, plantar fasciitis
• Costochondritis
• Bamboo spine on Xray

Question 4

Enthesitis

Answer 4

Inflammation of the entheses, the sites where tendons or ligaments insert into the bone

Question 5

Extra articular manifestations of ankylosing spondylitis

Answer 5

Osteoporosis
Acute iritis / anterior uveitis: 30%
Aortic valve incompetence
Apical pulmonary fibrosis

Question 6

Ix of ankylosing spondylitis

Answer 6

• Clinical Dx as radiological changes appear late
• Sacroliliitis: irregularities, sclerosis, erosions

• Vertebra: 
- corner erosions, squaring
syndesmophytes
- Bamboo spine: calcification of ligaments,
periosteal bone formation

• Bloods - FBC (anaemia), ↑ESR, ↑CRP, HLA-B27
• DEXA scan and CXR

Question 7

Mx of ankylosing spondylitis

Answer 7

Conservative:
- Exercise and physio

Medical:
NSAIDs: e.g. indomethacin
Anti-TNF: if severe
Local steroid injections
Bisphosphonates

Surgical:
Hip replacement to ↓ pain and ↑ mobility

Question 8

Genetic link

Answer 8

Associated with HLA-B27 allele

Question 9

Seronegative Spondyloarthropathies

Answer 9

Group of inflammatory arthritidies affecting the spine and peripheral joints without production of RFs

Question 10

Examples of seronegative Spondyloarthropathies

Answer 10

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis