Ankylosing spondylitis

Question 1

Epidemiology of Ankylosing Spondylitis

Answer 1

M:W 3:1, age of onset 20-40,

10-20x more common with 1st degree family history. Genetic component.

Question 2

Aetiology of Ankylosing Spondylitis

Answer 2

unknown - but often found in association with other spondyloarthropathies such as: RA, psoriatic arthritis, reactive arthritis, ulcerative colitis, chrons disease.
trauma
HLA B27

Question 3

Pathogenisis?

Answer 3

subchondral granulation tissue which erodes the joint which is then replaced with fibrocartilage and ossifies.
BAMBOO SPINE

Question 4

Natural history

Answer 4

relapsing-remitting chronic leading to fusion, bent over posture like a question mark
prone to fractures and wear and tear of peripheral its

Question 5

Manefestations

Answer 5

insideous onset over more that 3 months

Question 6

Symptoms

Answer 6

pain stiffness in back/buttock/neck
worse after rest better with most
pain in tendons/ligts
pain front chest/back of heel/ underneath foot

Question 7

Signs

Answer 7

Progressively worsening fixed kyphosis, inability to lay flat.
decrease ROM Lumbar spine - lateral/fwd
+ve schober test ie ,
decreased chest expansion

Xray - bilateral sacroiliitis grade 2
unilateral sacroilliitis grade 3-4

tests modified schobers - flexion lumbar
lateral flexion
Occiput to wall - cervical mobility
chest expansion - measured with a tape measure

Question 8

Complicatons

Answer 8

diminished chest expansion due to costovertebral involvement resulting in pulmonary fibrosis.

Spinal fracture and stenosis

Question 9

Prognosis

Answer 9

little to no disability with good management, but can be severe and disabling.