Ankylosing spondylitis Flashcards
Differentials for lower back pain?
ankylosing spondylitis, mechanical back pain, trauma, malignancy, infection, degenerative back pain
What are the extra-articular features of ankylosing spondylosis?
A's achilles tendonitis anterior uveitis amyloidosis apical lung fibrosis antlanto-axial subluxation AV node block Aortic incompetence
Which surface antigen test is positive in 90% of AS patients?
HLA-B27
Which is a late stage pathognomonic sign of AS?
bamboo spine
What is the treatment for ankylosing spondylitis?
NSAIDs + physio
DMARDs
Options for NSAIDs?
ibuprofen, naproxen, diclofenac,
COX-2 inhibitors (etorcoxib and celecoxib)
Things to check before prescribing NSAIDs?
renal function, hx reflux/ulcers/gastritis/IBD, hx bleeding, cardiac hx (SE), hx of asthma (exacerbation with NSAIDs)
What would be a typical hx of AS?
low back pain and stiffness for longer than 3 months which improves with exercise but is not relieved by rest
What would you find on examination of AS?
limitation of motion of lumbar spine in both saggital and frontal planes
Which investigations would you conduct in AS?
HLA B27, spinal and SIJ XR, whole spine and SIJ MRI
WHat is the management of AS?
NSAIDs, physio
Biological second line
Which special test can be used in spinal exam to support AS?
schoeber’s test, increase between the fingers of 5cm indicates spinal stiffness
Is HLA-DR4 associated with AS?
no, it is associated with RA and T1D
What is the definition of seronegative spondyloarthropathies
Group of inflammatory arthritidies affecting the spine and
peripheral joints w/o production of RFs and associated
with HLA-B27 allele.
Name three seronegative spondylartropathy conditions
psoriatic arthritis
ankylosing spondylitis
reactive arthritis
