Ankylosing Spondylitis

Question 1

Presentation of ank spond

Answer 1

1) Young adult male in late teens to early 20s.
2) Gradually developing symptoms for around 3 months
3) Lower back pain and stiffness and sacroiliac pain
4) Stiffness worse with rest and improves with movement
5) Worse pain at night and may wake them up
6) Takes around 30 mins in the morning to improve
7) Symptoms can fluctuate with flares
8) Vertebral fractures are the key complication of AS

Question 2

associations of ank spond

Answer 2

1) Systemic sx- weight loss and fatigue
2) Chest pain – costovertebral and costosternal joints
3) Enthesitis (where tendons or ligaments insert into bone)
4) Dactylitis
5) Aneamia
6) Anterior uveitis
7) Aortitis
8) Heart block
9) Restrictive lung disease
10) PF
11) IBD

Question 3

how do you carry out Schober’s test?

Answer 3

• This assesses the spine’s mobility.
• Get the patient to stand straight and find L5. Mark
• Mark 10cm above the spine and below 5 cm below this point.
• Ask the patient to bend forward and measure the distance between the points.
• If the distance is less than 20cm, this indicates a restriction in lumbar movement and can help support the diagnosis of ank spond.

Question 4

what investigations do you do in ank spond?

Answer 4

1) Inflammatory markers (CRP and ESR) may rise with disease activity.
2) HLA-B27 genetic test
3) X-ray of the spine and sacrum
4) MRI of the spine  bone marrow oedema

Question 5

what would you see on x-ray for ank spond

Answer 5

• “bamboo spine”
• Squaring of the vertebral bodies
• Subchondral sclerosis and erosions
• Syndesmophytes – areas of bone growth where ligaments insert into the bone.
• Ossification – where ligaments, discs and joints turn to bone.
• Fusion of the facet, sacroiliac and costovertebral

Question 6

management of ank spond ?

Answer 6

1) NSAIDs – useful for pain
2) Steroids – during flares, IM slow-release injection
3) Anti-TNF – etanercept
4) Monoclonal antibodies – infliximab, adalimumab
5) Secukinumab in severe disease

Question 7

what might you recommend for a patient with ank spond?

Answer 7

1) Physio
2) Exercise and mobilisation
3) Avoid smoking
4) Bisphosphonates to treat osteoporosis
5) Complications
6) Surgery for deformities of the spine or other joints.

Question 8

what gene is related to ank spond?

Answer 8

HLA-B27

Question 9

what is ank spond? what does it affect?

Answer 9

• AS is an inflammatory condition mainly affecting the spine causing progressive stiffness and pain.
• Mainly affects the sacroiliac joints and the joints of the vertebral column leading to pain and stiffness in those joints.
• It may progress to fusion of the spine and sacroiliac joints