Ankylosing Spondylitis

Question 0

Inflammation of the axial skeleton develops at sites where tendons insert into muscle.

True / False?

Answer 0

False.

Ligaments insert into bone.

Question 1

Define ankylosing spondylitis.

Answer 1

-progressive disorder of the axial skeleton presenting as pain n stiffness of the spine leading to bony ankylosis of the SI and spinal joints.

Question 2

What are the two types of A.S?

Answer 2

Marie Strumpell: most common

• S.I. Bilaterally and goes up
• prevalent mm wasting
• can affect jts of extremities

Bechterew: rare

• cervical and goes down
• jts of extremities never involved
• spinal meninges n nerve roots irritated

Question 3

A.S. Affects women more than men.

True / False?

Answer 3

False.

Equal now, or slightly less than men.

Question 4

Marie type is more common in women.

True / False?

Answer 4

False,

Bechetrew type, n is less progressive in women

Question 5

A.S is frequently seen in which populations?

Answer 5

Native North Americans

Rarely in Africans n Asians.

Question 6

How is the presentation of AS unique in comparison to males?

Answer 6

In women it presents asymmetrically.

Question 7

What age is AS commonly diagnosed in?

Answer 7

15-40.

Although can occur at any age.

Question 8

In children, AS affects the axial joints first.

True / False?

Answer 8

False.

Peripheral joints first.

May not have SI or lumbar involvement for months or years post onset.

Question 9

Why is AS considered a Seronegative Spondyloarthropathy?

Answer 9

Due to absence of Rheumatoid Factor

Question 10

What genetic marker is used to test for AS?

Answer 10

HLAB-B27
(90-95% pple with AS test + for it)

Though some people WITHOUT AS may also test positive for the marker thus test not conclusive.

Question 11

What is the cause of AS?

Answer 11

Idiopathic.

Question 12

What is the most common presentation of AS?

Answer 12

Inflammation of ligaments, periosteum and synovial of SI and lumbar joints

Question 13

When does fibrosis of the surrounding tissue occur and what does it lead to in AS?

Answer 13

When: recurrent exacerbations and remissions

Leads to: chronic disease that eventually becomes calcified and ossified.

Ossification leads too boney prominences or ridges which lead to BAMBOO SPINE.

Question 14

What are some complications of AS?

Answer 14

• osteoporosis leading to fractures
• caudal equine syndrome (refer out)
• aortic incompetence
• angina
• pericarditis
• atlantoaxial subluxation (refer out)

Question 15

A metabolic disorder caused by the production and deposition of protein-polysaccharide complex resembling starch is known as:

Answer 15

Amyloidosis

Associated with conditions such as Leprosy, RA, tuberculosis, AS and Hodgkin’s disease.

Question 16

AS is twice as common in people with a family history.

True / False?

Answer 16

False.

30 times more common.

Question 17

What are some postural changes one may see on patient with AS?

Answer 17

• bamboo spine (hypolordosis, hyper kyphosis, forward head carriage)
• question mark deformity (severe case)

Question 18

Why is bamboo spine and ligamentous calcification not good diagnostic tools for AS?

Answer 18

Take years to develop (10yr avg)

Occur in minority of people

Question 19

It is ok to pillow patient if fusion has not taken place in AS.

True / False?

Answer 19

False.

Only pillow when Spine is fused.

No pillow when SI jts fused only.

Question 20

Frictions should not be performed on sites with fusion or fibrosis.

True / False?

Answer 20

True.

Question 21

What types of hydrotherapy are useful in relieving muscle stiffness in fused AS?

Answer 21

• hydro collator
• whirlpool
• thermaphore etc

Question 22

Passive Free joint play and ROM is indicated to fused joints.

True / False?

Answer 22

False.

Contraindicated.

Question 23

Strengthening exercises for AS focus more on back extensors.

True / False?

Answer 23

True.