Ankylosing Spondylitis Flashcards
What are the key features of ankylosing spondylitis?
Chronic sacroiliitis
Spinal fusion (ankylosis)
Common demographic 20-30yr M
HLA B27
What is the presentation of AS?
Lower back pain and stiffness Early morning Improves with exercise Reduced spinal movements Sacroiliac pain - buttock pain Peripheral arthritis Plantar fasciitis, achilles tendonitis Fatigue
What are the extra-articular features of AS?
Anterior uveitis Atlanto-axial subluxation Achilles tendinopathy Apical fibrosis Aortic regurgitation AV conduction defect IgA nephropathy Amyloidosis
What can be seen on examination in AS?
Stooped posture: hyperextended neck, loss of lumbar lordosis, flexed hips and knees
What investigations are done in AS?
Bloods: normocytic anaemia, raised CRP/ESR, HLA B27
Imaging: Xray, T2 weighted MRI
Joint aspiration
What are the xray findings in AS?
Syndesmophytes
Sclerosis
Partial or total ankylosis
What can be seen on T2 weighted MRI in AS?
Squaring vertebral bodies Romanus lesion Erosion, sclerosis, narrowing SI J Bamboo spine Bone marrow oedema
What does joint aspiration look like in AS?
Sterile, cloudy fluid, raised WCC
What specialist tests may be important in AS?
Slit lamp examination - eyes
HRCT, lung function tests
Echo, ECG
Urine dipstic/PCR
What is first line treatment for AS?
NSAIDs
Physiotherapy
Other: hydrotherapy, education, exercise, stop smoking
What is second line treatment for AS?
Biologics - IF BASDAI >4 despite 1st line
- Anti-TNF first line
What is treatment for AS if anti-TNF fails?
Ustekinumab (anti IL-12/IL-23) or Secuilinimab (anti-IL-17)
What are some other options for AS treatment?
Peripheral joint disease management - sulfasalazine
Consider surgery where relevant
Manage risk factors for CVD
