Ankylosing Spondylitis Flashcards
What is meant by ankylosing spondylitis?
Ankylosing = stiffened
Spondylitis = back bone and inflammation
“inflammation of the vertebrae leading to stiffness”
What are the RF Ank. Spon?
- FHx (97% transferrance)
- HLA B27
- Most commonly seen in young males in their teens and early 20s
What is the pathophysiology underlying ank. spon?
Inflammation (like other inflammatory joint disease) PLUS OSSIFICATION
What is the early/initial clinical presentation?
- Insidious onset
- Inflammatory low back pain
- Pain may radiate to buttocks
- Pain may wake pt from sleep
What is the progressive clinical presentation?
- Loss of lordosis and exaggerated kyphosis
- Ossification of hip, costovertebral and costochondral joints (leading to dyspnoea)
What are the extra-articular invovlements?
- Iritis and uveitis
- Enthesitis especially plantar fasciitis, achilles tenditis, and the ischial tuberosities
What extra Ix can be ordered?
Pelvic X-ray: view sacroilitis (often a late symptom though)
How do we Dx ank spon?
Ank Spon. is predominantly a clinical diagnosis + grading through sacroilitis
What is the main management for ank spon? Outline the 1st line, adjunct and if symptoms progress.
1st line: NSAIDs and physiotherapy (daily stretches)
- Ibuprofen
- Naproxen
- Diclofenac
Adjunct: analgesics
- WHO step ladder
Other:
- Corticosteroid injection
- Sulfasalazine (this is the only DMARD that is effective) in peripheral joint invovlement
