Ankylosing spondylitis

Question 1

Ankylosing spondylitis presentation

Answer 1

• usually young men
• insidious onset back pain and stiffness
• stiffness improves with exercise
• may have night pain that improves in getting up

Question 2

Ankylosing spondylitis differentials

Answer 2

• mechanical back pain
• spinal stenosis
• rheumatoid arthritis
• infectious sacroilitis

Question 3

Ankylosing spondylitis examination findings

Answer 3

• reduced lateral flexion
• reduced forward flexion (Schober’s)
• reduced chest expansion

Question 4

Ankylosing spondylitis associations

Answer 4

• anterior uveitis
• Achilles tendonitis
• aortic regurgitation
• amyloidosis
• cauda equina syndrome

Question 5

Ankylosing spondylitis investigations

Answer 5

• always refer if suspected
• ESR and CRP often raised but not diagnostic
• plain X-ray of sacroiliac joints (sacroiliitis: subchondral erosions, sclerosis, squaring of lumbar vertebrae, ‘bamboo spine’, syndesmophytes)
• can have MRI if suspicion remains
• restrictive spirometry
• New York diagnostic criteria

Question 6

Ankylosing spondylitis management

Answer 6

• NSAIDs are first line
• encourage regular exercise, e.g. swimming
• physiotherapy
• DMARDs for rheum if peripheral joint involvement
• anti-TNF therapy if treatment fails