Ankylosing Spondylitis Flashcards
Ankylosing spondylitis is the abnormal stiffening pain in the s______ and v___ joints due to new bony formations
sacroiliac and vertebral
What can ankylosing spondylitis progress to?
Spine and sacroiliac joint fusion
Who is most at risk of ankylosing spondylitis?
Young males, HLA B27 positive
What is a syndesmophyte?
Vertical abnormal bony growth
Syndesmophytes replace the spinal bone damaged by inflammation and make the spine ____ mobile
less
Ankylosing spondylitis can cause inflamed t___, e___ and f____ along with back stiffness
tendons, eyes, fingers
How may a patient with ankylosing spondylitis present?
Progressively worsening back stiffness, worst in morning, better with exercise
Anterior uveitis
Enthesitis (tendons or ligaments insert into bone)
Dactylitis
Lumbar pathology
SOB
How long do the symptoms take to develop?
Usually relatively slow onset, over 3 months
What are the 2 observations of lumbar pathology in ankylosing spondylitis?
Decreased natural lumbar lordosis (lower back curve, more kyphosis)
Schober test shows decreased lumbar flexion of less than 20 cm
How do you diagnose ankylosing spondylitis?
Spine or pelvis X-ray:
Bamboo spine (fused back bones)
Sacroiliitis
Squared vertebral bodies
Syndesmophytes
MRI:
Can show sacroiliitis before X-ray so is a better screening tool
Serology:
Raised ESR and CRP
HLA-B27 positive
How do you manage ankylosing spondylitis?
Manage symptoms by exercising and NSAIDs
If severe, steroid injections
DMARD can improve disease
TMF-a blockers like infliximab or etanercept
last resort = surgery
What are additional (lifestyle) changes to help manage ankylosing spondylitis?
Physio
Exercise and mobilisation
Smoking cessation
Bisphosphonates for osteoporosis
What diseases is it associated with?
Crohn’s and ulcerative colitis
