Ankylosing Spondylitis Flashcards
What is ankylosing spondylitis?
HLA B27, seronegative autoimmune spondyloarthropathy. Collagen gets destroyed and is replaced by fibrin. It results in fusion of the spine and sacroiliac joints. It can also present with anterior uveitis and arteritis
What is the presentation of ankylosing spondylitis?
- Men ages 20-30 years old but don’t forget women!
- Inflammatory back pain with early morning stiffness lasting over 30mins. Pain may radiate to buttock.
- Tender sacroiliac joints
- Peripheral enthesitis and arthritis
- Extra-articular involvement
- Symptoms can fluctuate with flares
What are the other features of ankylosing spondylitis?
- Apical fibrosis,
- Anterior uveitis,
- Aortic regurgitation and aortitis
- Anaemia
- Achilles tendonitis
- AV node block (due to fibrosis of conductive system
- Amyloidosis,
- Cauda equina
- Systemic symptoms (fever, weight loss)
What are the clinical examination findings of ankylosing spondylitis?
- Reduced lateral flexion,
- Reduced forward flexion (Schober’s test)
- Reduced chest expansion
What are the investigations for Ankylosing Spondylitis
- Inflammatory markers (CRP and ESR
- HLA B27 genetic test
- X-ray of spine and sacrum
- MRI of spine can detect bone marrow oedema (ealy sign)
What are the bony bridges called in ankylosing spondylitis?
Syndesmophytes. This can lead to fusion of the vertebral column called bamboo spine
What are the x ray changes seen in ankylosing spondylitis?
Squaring of vertebral bodies,
Subchondral sclerosis,
Syndesmophytes,
Ossification (fibrous tissue turns to bone) of ligaments
Fusion of facets, sacroliiac and costovertebral joints
What is the treatment for ankylosing spondylitis?
First line is NSAIDs (+PPI) and physiotherapy and exercise.
Steroids can be used in flares.
DMARDs are only used if there is peripheral joint involvement as they do not improve spinal inflammation.
Anti-TNF can be used if there is persistently high disease
