Ankylosing spondylitis Flashcards
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the vertebral joints and makes the spine really stiff.
- ankylosing = stiffening
- spondylo = vertebra
- itis = inflammation
What is the incidence of AS?
1 - 0.8 cases per 100,000
2 - 8 cases per 100,000
3 - 80 cases per 100,000
4 - 800 cases per 100,000
2 - 8 cases per 100,000
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the vertebral joints and makes the spine really stiff. What is the mean age affected by AS?
1 - 5-10
2 - 10-20
3 - 20-30
4 - 40-60
3 - 20-30
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the vertebral joints and makes the spine really stiff. Does AS affect men or women more?
- men
- 3:1
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the vertebral joints and makes the spine really stiff. AS is classed as a seronegative spondyloarthropathies. Does this mean that rheumatoid factor (RF), an autoantibody, is or is not found in the blood?
- RF is not found in the blood
In between each of the vertebrae in the vertebral column is a intervertebral disc that acts as a shown absorber. What are the 2 main components of the vertebral disc?
1 - fibrinogen
2 - cartilage
3 - type 1 collagen
4 - type IV collagen
3 - type 1 collagen
4 - type IV collagen
In between each of the vertebrae in the vertebral column is a intervertebral disc that acts as a shown absorber. What is the name of the centre of the vertebral disc?
1 - nucleus pulposus
2 - nucleus accumbens
3 - annulus fibrosis
4 - annulus collagenous
1 - nucleus pulposus
In between each of the vertebrae in the vertebral column is a intervertebral disc that acts as a shown absorber. What is the name of the disc surrounding the nucleus pulposus of the vertebral disc?
1 - nucleus fibrosis
2 - nucleus accumbens
3 - annulus fibrosis
4 - annulus collagenous
3 - annulus fibrosis
What is the name of the joints that connect each vertebrae with the vertebrae above and below it?
1 - nucleus joints
2 - facet joints
3 - flat joints
4 - fixed joints
2 - facet joints
In ankylosing spondylitis (AS) which 2 aspects of the vertebral column are affected?
1 - ligamentum flavum
2 - facet joints
3 - vertebral disc
4 - articular processes
2 - facet joints
3 - vertebral disc
Although the exact cause of ankylosing spondylitis (AS) remains unknown, it is classed as an autoimmune disease, where type I and IV collagen in the spine is attacked. Which human leukocyte antigen (HLA) has been linked with AS, with approx 90% of patients having it?
1 - HLA-DR2
2 - HLA-DQ2
3 - HLA-DR3
4 - HLA-B27
4 - HLA-B27
- form of MHC-1, which is sampled by cytotoxic CD8 T cells
- MHC-1 present self antigens
Most patients with ankylosing spondylitis (AS) have HLA-B27. If cytotoxic CD8 T cells recognise the MHC-1 antigen as none self they release cytokines that recruit other immune cells to the area to attack the antigen presenting cell. What is the main cell recruited?
1 - macrophages
2 - eosinophils
3 - B cells
4 - basophils
2 - eosinophils
- release TNF-a and IL-1
In patients with ankylosing spondylitis (AS) the immune system attacks the type I and IV collagen in the vertebral discs and facet joints. They become chronically inflamed and destroy these joints leading to the deposit of fibroblasts and fibrin deposition that form tough fibrous bands around joints. Does this increase or decrease the range of motion at these joints?
- decreases the range of motion
In patients with ankylosing spondylitis (AS) the immune system attacks the type I and IV collagen in the vertebral discs and facet joints. This leads to fibrous bands around joints and reduces the range of motion. Eventually what does this lead to the activation of?
1 - complement pathway activation
2 - coagulation cascade
3 - osteoclast activation
4 - osteoblast activation
4 - osteoblast activation
- syndesmophytes (small bony outgrowths) begin to occur between vertebrae
- spine with these becomes immobile
In ankylosing spondylitis (AS) the eye can be affected causing what?
1 - conjunctivitis
2 - anterior uveitis
3 - cataracts
4 - glaucoma
2 - anterior uveitis
- uvea = iris, ciliary muscle and choroid
In ankylosing spondylitis (AS) a valve of the heart can become inflamed and damaged. Which valve is commonly affected?
1 - aortic valve
2 - pulmonary valve
3 - tricuspid valve
4 - mitral valve
1 - aortic valve
- valve becomes stiff and damaged causing aortic regurgitation
In ankylosing spondylitis (AS) tendons can become inflamed and damaged. Which tendon is most commonly affected?
1 - patellar tendon
2 - subscapularis tendon
3 - achilles tendon
4 - pectoralis major tendon
3 - achilles tendon
- called enthesitis
Clinically do patients with ankylosing spondylitis (AS) have stiffness in the morning or worse in the evenings?
- mornings
- gets better with movement
Clinically do patients with ankylosing spondylitis (AS) can the pain from the spine cause the patient to wake in the evening?
- yes
- gets better once up and moving around
What is the most common joint affected in the spine in patients with ankylosing spondylitis (AS)?
1 - lumbar sacral joints
2 - sacroiliac joint
3 - cervical joints
4 - thoracic joints
2 - sacroiliac joint
- causes buttock pain
In patients with ankylosing spondylitis (AS) we can perform Schobers test, which will confirm what?
1 - reduced rotation in AS
2 - increased forward flexion in AS
3 - reduced forward flexion in AS
4 - increased lateral flexion
3 - reduced forward flexion in AS
In patients with ankylosing spondylitis (AS) we can perform Schobers test, which can confirm reduced forward flexion. Which 2 of the following can present in patients with AS?
1 - reduced thoracic expansion
2 - increased forward flexion in AS
3 - increased forward extension in AS
4 - reduced lateral flexion
1 - reduced thoracic expansion
- can lead to SOB confirmed on spirometry
4 - reduced lateral flexion
In patients with ankylosing spondylitis (AS) is the pain in the spine insidious or typically following trauam/accident?
- insidious
Which of the following constitutional symptoms does NOT commonly present in ankylosing spondylitis (AS)?
1 - malaise
2 - fever
3 - fatigue
4 - weight gain
4 - weight gain
- typically causes weight loss
If a patient presents to the GP with suspected ankylosing spondylitis (AS), which of the following should occur?
1 - treat with NSAIDs and physio
2 - lifestyle change
3 - refer to specialist
4 - disease-modifying antirheumatic drugs (DMARDs)
3 - refer to specialist
