ankylosing spondylitis

Question 1

Complications/extra-articular manifestations

Answer 1

Apical fibrosis
Anterior uveitis
Achilles tendonitis
AVN block/arrhythmia
Amyloidosis/ IgA nephropathy
Aortic regurg/aortitis
Atlantoaxial subluxation

Question 2

DDx

Answer 2

PsA
IBD arthritis
Reactive arthritis

OA
Mechanical back pain
Malignancy

Question 3

Ix

Answer 3

Obs: BP
Urinalysis (?protein)
ECG: AVN block/ LVH from AR
CXR/CT Lung fibrosis
Lung function testing
Echocardiogram: AR

Question 4

Scoring system for AS

Answer 4

BASDAI

Question 5

Important -ve in a back pain history

Answer 5

Signs of cord compression/ cauda equina

Question 6

AS Ix

Answer 6

Obs: BP (wide?), o2 sats
Urinalysis for proteinuria
ECG: AVN block of LVH from AR
Pulm function tests

Bloods: FBC, UE, CRP/ESR, HLA-B27

Imaging:
CXR
CT if fibrosis suspected

X ray SIJ
MRI spine

Special tests: spirometry

Question 7

Mx

Answer 7

MDT: Rheumatologist, physio/oT, GP, AS support groups

Non-pharm: exercise, weight loss, physiotherapy, monitoring in clinic for extra-articular SE
SMOKING CESSATION

Medical: Paracetamol, NSAIDs, if failed x2 -> biologics (Anti-TNF)/DMARDs (MTX for peripheral disease)
Steroid injections

Surgical: joint replacement

Question 8

Causes of SOB in AS

Answer 8

Apical fibrosis
Mechanical restrictive defect
TB from immunosuppression

Question 9

Renal complications of AS

Answer 9

AA Amyloidosis, IgA nephropathy, chronic NSAID use

Question 10

Back pain red flag sx

Answer 10

Bowel or bladder incontinence
Sudden onset back pain/trauma
Cancer sx
Sensory disturbance - saddle anaesthesia
new leg weakness

Question 11

Pain sx specific to AS

Answer 11

Buttock pain
Night pain

Question 12

Systems to examine

Answer 12

Gait
Skin + nails
Any particularly problematic joints
Eyes
Palpate spine and SIJ
Back and neck ROM (schobers, occiput to wall)
Tendons for tendonitis
CVS
Resp
+/- neuro

Question 12

XR changes in AS

Answer 12

Sacroilitis, SIJ fusion syndesmophytes -> bamboo spine, squaring of vertebrae