ankylosing spondylitis .

Question 1

what is ankylosing spondylitis

Answer 1

chronic inflammatory disease of the axial skeleton

leads to partial or complete fusion and rigidity of the spine

Question 2

what is the gene that can predispose to ankylosing spondylitis

Answer 2

HLA B27

Question 3

what is the tipical age of onset of ankylosing spondylitis

Answer 3

20-40

Question 4

describe the articular symptoms of ankylosing spondylitis

Answer 4

spinal and neck pain

morning stiffness that lasts >30 mins and improves with activity

Question 5

describe the articular symptoms of late ankylosing spondylitis

Answer 5

loss of lumbar kyphosis with pronounced cervical lordosis (questionmark posture)

Question 6

descibe the clinical signs of ankylosing spondylitis

Answer 6

reduced chest expansion

inflammatory enthesitis - e.g. achilles, iliac crests - painful on palpation

positive occiput to wall test

positive schobers test

Question 7

what is the schobers test

Answer 7

mesure 5cm below the posterior superior iliac crests and 10cm above with pt upright, remeasure when bending forwards

normally above 20cm

Question 8

describe occiput to wall test

Answer 8

pt stands against wall and shouldbe able to touch occiput to wall

Question 9

what are the extra articular features of ank spond

Answer 9

anterior uveitis

CV involvement e.g. aortic regurgitation

pulmonary involvement e.g. upper lobe fibrosis

asymptomatic enteric mucosal inflammation

amyloidosis

Question 10

what are the investigations used in suspected ank spond

Answer 10

bloods (inflammatory markers, HLA B27), X ray, MRI

Question 11

what ado blood results show in ank spond

Answer 11

raised inflammatory markers

HLA B27

Question 12

what are X ray findings in ank spond

Answer 12

bone density normal in early disease, reduced later

sclerosis and fusion of SI joints

bony spurs from vertebral bodies can bridge discs and case fusion

CAN BE NORMAL AT TIME OF PRESENTATION

Question 13

MRI results in ank spond

Answer 13

can detect sacrolitis (active inflammation)

earlier changes e.g. bone marrow oedema and enthesitis of spinal ligaments

Question 14

what is the non-pharmacological management of ank spond

Answer 14

physio

OT

chiropodist

orthotics

Question 15

pharmacological management of ank spond

Answer 15

NSAIDs - first line

symptomatic - corticosteroids/ joint injections

DMARDs e.g. methotrexate or sulfasalazine

Question 16

surgical options in ank spond

Answer 16

mainly reserved for hip and knee arthritis

kyphoplasty is an option but controversial and risky