Ankylosing spondylitis Flashcards
What are spondylarthropathies
Group of clinically heterogeneous inflam rheumatologic condtiions
Axial, sacroiliac joints + spine
Peripheral - psoriatic arthritis, reactive, enteropathic
What is ankylosing spondylitis
Axial spondyloarthritis - sacroilitis on X ray
Can be absent on X ray
Features of ankylosing spondylitis
Chronic back pain - stiffness that improves with exercise
Sacroiliac joint and spinal fusion
Arthritis and enthesitis (lower limb, asymmetrical)
Dactylitis
Fatigue
Extra articular manifest
What are syndesmophytes
Bony growths in IV joint ligaments in spine
Extra articular manifestations of ank spond
Anterior uveitis
Psoriasis
IBD
Cause of ank spond
HLA-B27
Genetic predisoposition triggered by environmental factors
Who gets ank spond
2 x men than women
20-30 year onset
Majority under 45 years when diagnosed
What are people with spinal rigidity more at risk of
Spinal fractures
Complications of ank spondylitis
Ankylosis/spinal fusion
Aortic regurgitiation
Spinal fractures
Hip involvement
Anterior uveitis
Osteoporosis
Cardiac complications - aortic and non-aortic valvular heart disease and congestive heart failure. Arrhythmias
Lung involvement - restrictive pulm disease, apical fibrosis,
Neuro involvement - vertebral fracture, dislocation, cauda equina
Adverse effect from dugs
QOL decreased
What see on MRI/x-ray
Persitent or fluctuating acial inflammation and new bone formation
When sus ank spond
<45 yrs
Back pain > 3 months
Inflammatory, worse in morning, improves with movement
Current or prev buttock pain, thoracic or cervical spine pain, arhritis, enthesitis, ant uveitis, psoriasis or IBD
Symptoms awake in nght
Responsive to NSAIDs in 48 hours
FH of ank spond
Diagnostic criteria for ank spond
Modified NY crtierira
Assessment of spondyloarthritis International society
Clinica criteris NY criteria
Low back pain; > 3 months; improved by exercise but not relieved by rest. Limitation of lumbar spine motion in both the sagittal and frontal planes. Limitation of chest expansion relative to normal values for age and sex
NY criteria for ank spond
Definite - radiological criteria + at least on clinical criteria
Porbably = 3 clinical criteria OR radiology alone
ASAS classification of ank spond
,45 years + >3 months back pain
Sacroilitis on imagine + 1 or more spondyloarthritis featires
OR
HLA-B27 + and 2 or more spondyloarthritis features
Spondyloarthritis features according to ASAS criteria
Inflammatory back pain
Arthritis
Enthesits
Uveitis
Dactylitis
Psoriasis
IBD
Responsive to NSAIDs
FH
HLA-B27
Elevated CRP
Investiationg for AP
CRP, ESR
Basine bloods
X ray of spine
MRI - more senstivit, if no changes on C ray
HLA-B27
Spirometry
Differentials ank spond
Degenerative or mechanical probelms eg disc, sponylosis, osteoarthritis
Fractures.
Infectious sacroiiitis.
Bone metastasis.
Primary bone tumours.
Spinal stenosis.
Hypermobility.
When refer to rheumatology for ank spond
<45 + > 3 months of back pain +>4 of following:
Low back pain before 35
Wake during second hlf night w pain
Buttock pain
Improvement when moving, taking NSAIDs in 48 hours
first degree relative
Current or past arthritis, enthesits, psoriasis
HLA-B27 if 3 criteria
What is anterior uveitis
Eye -> red, acutely painful, photphobia, blurred vision
First line for ank spond
NSAID eg naproxen
If uncontrolled change or add another analgesia eg paracetmol, codeine
How often should someone with ank spond have a DEXA scan
Every 2 years
What need to be aware of in DEXA scans in ank spond
Bone mineral density may be increased on spine DEXA - syndesmophytes and ligament calcification
Do hip DEXA
When refer ank spond
Vertebral fracture
Refractory hip pain or diasbility + structural damage onx ray for hip arthroplasty
Severe or progressive deformity of spine affecting QOL
X ray changes in akylosing spondylitis
Sacroilitis - subchondral lesions, sclerosis
Squaring of lumbar vertebrae
Bamboo spine - late
Syndesmophytes - ossification of outer fibres of annulous fibrosus
CXR - apical fibrosis
Why may spirometry be low in ank spond
Pulmonary fibrosis, kyphosis, ankylosis of costovertebral joints
general mangement of ank spond
Regular exercise sp swimming
Physio
NSAIDs
DMARDs eg sulfasalzine only if peripheral joint involevemnt
Anit-TNF therapy if persistently high disease acitivty despite treatments eg etnercept, adalimumab
