ankylosing spondylitis

Question 1

what is it

Answer 1

inflammatory condition mainly affecting the spine

key joints involved = sacroiliac and vertebral column

inflammation causes joint pain and stiffness and can progress to fusion of joints
‘bamboo’ spine

HLA b27 gene in 90% of patients

Question 2

how does AS present

Answer 2

young male in late teens or 20s
symptoms gradually develop over 3 months
and can fluctuate with flares

lower back pain + stiffness pain in buttock region
worse with rest/improves with activity
worse at night and in the morning - may wake from sleep

Question 3

associated symptoms of AS

Answer 3

weight loss
fatigue
chest pain - costovertebral + costosternal joints
enthesitis = inflammation where ligaments/tendons meet bone (plantar fasciitis, achilles tendonitis)
dactylitis
anterior uveitis
aortitits + heart block
inflammatory bowel disease

Question 4

investigations

Answer 4

> Shober’s test
-assess mobility in spine
-find L5 vertebra, mark point 10cm above + 5cm below this point
-ask patient to bend forward as far as they can + measure distance between points
and if the distance <20cm = restriction in lumbar movement

> CRP + ESR - raised
HLA B27 genetic test
x-ray of spine and sacrum
-bamboo spine
-squaring of vertebral bodies
-subchondral sclerosis + erosion
-syndesmophytes = areas of bone growth where ligaments insert into bone
-ossification of ligaments, discs, and joints (they turn to bone)
-fusion of facet, sacroiliac + costovertebral joints

> MRI of spine