Ankylosing Spondylitis

Question 1

What is ankylosing spondylitis?

Answer 1

An inflammatory condition of the axial skeleton (mainly spine & sacroiliac joints).

Causes progresses pain and stiffness.

Question 2

What group of conditions is ankylosing spondylitis (AS) a part of?

What 2 other conditions are also part of this group?

Answer 2

Seronegative spondyloarthropathy group of conditions.

Also includes:
1) reactive arthritis
2) psoriatic arthritis

Question 3

What are the 2 main affected joints in AS?

Answer 3

1) Sacroiliac joints

2) Vertebral column joints

N.B. can progress to spine and sacroiliac joint fusion

Question 4

Who does AS typically present in?

Answer 4

Males aged 20-30 y/o

Question 5

What gene does AS have a strong link with?

Answer 5

HLA-B27 gene

Question 6

What are the 2 main presenting symptoms of AS?

Answer 6

1) Pain and stiffness in the lower back

2) Sacroiliac pain (in the buttock region)

Symptoms develop gradually over at least 3 months.

Question 7

How does movement & rest affect pain in AS?

Answer 7

Worse with rest

Improves with movement/activity

Question 8

When is AS pain during the day?

Answer 8

Worse at NIGHT and in the MORNING (may wake them)

Question 9

Clinical findings on examination in AS? (3)

Answer 9

• Reduced lateral flexion
• Reduced forwards flexion
• Reduced chest expansion

Question 10

What are some additional symptoms and problems that can be seen in AS?

Answer 10

1) Chest pain (related to the costovertebral and sternocostal joints)

2) Enthesitis

3) Dactylitis

4) Vertebral fractures

5) Shortness of breath (relating to restricted chest wall movement)

Question 11

What is enthesitis?

Answer 11

Inflammation of the entheses, where tendons or ligaments insert into bone

Question 12

What test can be used to assess spinal mobility in AS?

Answer 12

Schober’s test

Question 13

What is Schober’s test?

Answer 13

With the patient standing straight, the L5 vertebra is located, and a point is marked 10cm above and 5cm below this level (15cm apart).

Then the patient bends forward as far as possible, and the distance between the points is measured.

A length <20cm indicates a restriction in lumbar movement –> helps support a diagnosis of AS.

Question 14

What 5 other conditions can be associated with AS? (5 A’s)

Answer 14

Anterior uveitis

Aortic regurgitation

AV block

Apical lung fibrosis

Anaemia of chronic disease

Question 15

What is the most useful investigation in establishing a diagnosis of AS?

Answer 15

XR of the sacroiliac joints

Question 16

What are some XR findings in AS?

Answer 16

1) Squaring of the vertebral bodies

2) Subchondral sclerosis and erosions

3) Syndesmophytes (areas of bone growth where the ligaments insert into the bone)

4) Ossification of the ligaments, discs and joints (these structures start turning into bone)

5) Fusion of the facet, sacroiliac and costovertebral joints

Question 17

What is a bamboo spine?

Answer 17

The typical x-ray finding in the later stages of AS, where there is fusion of the sacroiliac and spinal joints.

Question 18

1st line medical mx of AS?

Answer 18

NSAIDs

(also encourage regular exercise)