ankylosing spondylitis Flashcards
what is ankylosing spondylitis
inflamed spine growing together
- characterized by symmetric sacroiliitis and progressive inflammatory arthritis
what are spondylarthropathies
- family of related disorders linked by common pathology
- characterized by chronic inflammation involving SI joints, axial skeleton, and peripheral joints to a lesser degree
spondylarthropathies are associated with what gene
HLA-B27
what percentage of people with ankylosing spondylitis have the HLA-B27 gene
90%
*only 1-2% of people with HLA-B27 develop ankylosing spondylitis
age of onset of ankylosing spondylitis
late teens to young adults
male:female = 3:1
what pathophysiology causes ankylosing spondylitis
inflammation at site of insertion of ligaments and tendons into bone
- over time, process leads to ossification
clinical presentation
- aching low back pain, around SI joint area
- persistant morning back stiffness for more than 1 hr
- pain can awake them in the morning
- stiffness exacerbated by inactivity and improves with moderate activity
Ankylosing Spondylitis
Ankylosing Spondylitis disease progresses in which direction
proximally
Is Ankylosing Spondylitis a systemic disease?
yes
what constitutional symptoms may occurs during an acute exacerbation of Ankylosing Spondylitis
- low grade fever
- fatigue
- weight loss
- night sweats
*more common in adolescents than adults
what is the most frequent and most important extra-articular manifestation of Ankylosing Spondylitis
acute anterior uveitis (iritis)
*present in 25% of patients with AS
Describe the prodrome of anterior uveitis (iritis) that is associated with Ankylosing Spondylitis
- eye discomfort or HA
- severe eye pain, redness, photophobia, blurry vision, increased lacrimation
- circumcorneal flush
Does the anterior uveitis (iritis) that is associated with Ankylosing Spondylitis usually affect one eye or both eyes? When does it resolve?
- unilateral
- episodes usually resolve over 2-3 months
what are some other extra-articular symptoms associated with Ankylosing Spondylitis
- AV block
- Aortic regurgitation
- Neurologic: cauda equina syndrome secondary to fx
- TMJ dysfunction
- fibromyalgia
What Physical exam findings would you expect to see in Ankylosing Spondylitis
- limited spinal motion always
- tenderness over SI joints
- loss of lumbar lordosis (curve)
- accentuated thoracic kyphosis
what is the shober test
- test for AS
- intersection of iliac crests and spine
- mark 10 cm above and 5 cm below intersection
- have patient forward flex as much as possible
- re-measure distance between marks
- total distance should be > 20 cm..normal to have at least 5 cm of movement
what abnormal lab tests would you expect to see with ankylosing spondylitis
- **no specific test for AS
- CBC: normochromic/normocytic anemia
- ESR and/or CRP elevated in 75%
- alkaline phosphatase elevated in 50% due to ossification
why would you/would you not test a patient for HLA-B27
negative result in more useful in excluding diagnosis than a positive result in in confirming diagnosis
bamboo spine is related to what condition
ankylosis spondylitis
what is the first line treatment for ankylosing spondylitis
NSAIDs
- indomethacin (Indocin) considered most effective
- may consider celecoxib (Celebrex)
second line of treatment for ankylosing spondylitis if conservative treatment fails
- rheumatology referral
- tumor necrosis factor alpha antagonists
- azulfidine: peripheral arthritis
- intra-articular steroids used no more than every 3-4 months
treatment if you see iritis/uveitis symptoms
refer to opthalmology
supportive measures for ankylosing spondylitis
- daily exercise is essential
- stretching and strengthening exercises
- PT
