ankylosing spondylitis

Question 1

what is it?

Answer 1

chronic inflammatory disease of axial skeleton (vertebral joints)

Question 2

what can it lead to?

Answer 2

partial or complete fusion and rigidity of spine

Question 3

what is pathophysiology?

Answer 3

becomes more kyphotic over age - until disc is fused

Question 4

what are clinical symptoms?

Answer 4

“A” disease
anterior uveitis
aortic insufficiencies
apical pulmonary fibrosis

Question 5

what are the articular symptoms?

Answer 5

spinal and neck pain - gradual onset of dull pain that progresses slowly
morning stiffnses >30 mins improves with activity
question mark spine - late

Question 6

what causes question mark spine?

Answer 6

loss of lumbar kyphosis and pronounced cervical lordosis

Question 7

what are clinical signs?

Answer 7

schobers test - 5cm below, 10cm above, should be >20cm, measures lumbar spine flexion
reduced chest expansion
iliac crest - pain on palpation (inflammatory)

Question 8

what investigations can be used?

Answer 8

bloods
x-ray
MRI

Question 9

what is 1st line test?

Answer 9

x-ray

Question 10

what will bloods show?

Answer 10

raised inflammatory markers
HLA B27

Question 11

what will x-ray show?

Answer 11

BAMBOO SPINE
may show sclerosis and fusion of sacroiliac joints

Question 12

what is bamboo spine?

Answer 12

ossification of annulus fibrosis (lumbar spine)

Question 13

what will MRI detect?

Answer 13

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

Question 14

what is 1st line management?

Answer 14

NSAIDs

Question 15

what is treatment?

Answer 15

same as spondyloarthropathies