Ankylosing spondylitis Flashcards
What is ankylosing spondylitis associated with?
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy.
What is the typical demographic for ankylosing spondylitis?
Typically presents in males aged 20-30 years old with a sex ratio of 3:1.
What are the typical symptoms of ankylosing spondylitis?
Lower back pain and stiffness of insidious onset, worse in the morning and improves with exercise.
What may the patient experience at night with ankylosing spondylitis?
Pain at night which improves on getting up.
What are the clinical examination findings in ankylosing spondylitis?
Reduced lateral flexion, reduced forward flexion, and reduced chest expansion.
What is Schober’s test?
A test where a line is drawn 10 cm above and 5 cm below the back dimples. The distance should increase by more than 5 cm when the patient bends forward.
What are the other features associated with ankylosing spondylitis?
Apical fibrosis, anterior uveitis, aortic regurgitation, Achilles tendonitis, AV node block, amyloidosis, cauda equina syndrome, and peripheral arthritis (25%, more common if female).
What is ankylosing spondylitis associated with?
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy.
What is the typical demographic for ankylosing spondylitis?
It typically presents in males aged 20-30 years old with a sex ratio of 3:1.
What inflammatory markers are typically raised in ankylosing spondylitis?
ESR and CRP are typically raised, although normal levels do not exclude ankylosing spondylitis.
What is the usefulness of HLA-B27 in diagnosing ankylosing spondylitis?
HLA-B27 is of little use in making the diagnosis as it is positive in 90% of patients with ankylosing spondylitis and 10% of normal patients.
What is the most useful investigation for establishing the diagnosis of ankylosing spondylitis?
Plain x-ray of the sacroiliac joints is the most useful investigation.
What are some later changes seen in x-rays of ankylosing spondylitis?
Later changes include sacroiliitis (subchondral erosions, sclerosis), squaring of lumbar vertebrae, ‘bamboo spine’ (late & uncommon), and syndesmophytes due to ossification of outer fibers of annulus fibrosus.
What should be done if the x-ray is negative but suspicion for ankylosing spondylitis remains high?
The next step should be obtaining an MRI to confirm the diagnosis.
What might spirometry show in ankylosing spondylitis?
Spirometry may show a restrictive defect due to a combination of pulmonary fibrosis, kyphosis, and ankylosis of the costovertebral joints.
What are the management recommendations for ankylosing spondylitis based on the 2010 EULAR guidelines?
Management includes encouraging regular exercise such as swimming, using NSAIDs as the first-line treatment, physiotherapy, and considering anti-TNF therapy for patients with persistently high disease activity.
When should anti-TNF therapy be considered in ankylosing spondylitis?
Anti-TNF therapy should be given to patients with persistently high disease activity despite conventional treatments.
What ongoing research is being conducted regarding anti-TNF therapies?
Research is ongoing to see whether anti-TNF therapies such as etanercept and adalimumab should be used earlier in the course of the disease.
