Ankylosing spondylitis

Question 1

which HLA is associated with spondyloarthropathy?

Answer 1

HLA-B27

Question 2

is it more in males or females? and what age?

Answer 2

more in males and presents at 20-30 years

Question 3

Features of ankylosing spondylitis

Answer 3

• young men with lower back pain
• stiffness of insidious onset
• stiffness worse in morning and improve with exercise
• pain at night which improves on getting up

Question 4

Clinical examination for ankylosing spondylitis

Answer 4

• reduced lateral flexion
• reduced forward flexion (schooner’s test)
• reduced chest expansion

Question 5

other features of ankspon

Answer 5

the As
- apical fibrosis
- anterior uveitis
- aortic regurgitation
- achilles tendonitis
- AV node block
- Amlyoidosis
- cauda equina syndrome
- peripheral arthritis (more common in female)

Question 6

Investigations for ankspon

Answer 6

• raised inflammatory markers (CRP, ESR)
• HLA-B27 positive
• plain Xray of sacroiliac joints (most useful)
• negative Xray then MRI
• bone marrow edema confirm AS

Question 7

features of AS on Xray

Answer 7

• sacroiliitis (subchondral erosion and sclerosis)
• squaring of lumbar vertebrae
• bamboo spine (late and uncommon)
• Syndesmophytes
• chest Xray- apical fibrosis

Question 8

what features in spirometry will be seen in AS

Answer 8

• restrictive defect
  due to
• pulmonary fibrosis
• kyphosis
• anklylosis of the costovertebral joints

Question 9

Management of AS

Answer 9

• regular exercise
  1st line treatment - NSAIDs
• physiotherapy
• peripheral joint involvement- sulphasalazine (used for RA)