Ankylosing spondylitis Flashcards
What is Ankylosing spondylitits?
A chronic inflammatory process that causes stiffness of the spinal and sacroiliac joints
What is the epidemiology of Ankylosing spondylitis?
Effects men more than women
Tends to occur in early adult life eg 20s
95% are HLA-B27+ve
What are Seronegative Spondyloarthropathies?
Group of inflammatory disorders effecting spine/peripheral joints without production of RF
Association with HLA-B27 allele
What are some of the extra articular complications of Ankylosing spondylitis?
Osteoporosis - 60% Anterior uveitis - 30% Iritis - 30% IBD Oral ulcers Aortic regurgitation -
How does Ankylosing Spondylitis present?
Gradual onset of back pain
Progressive loss of spinal movements
Costochondritis (Inflammation of of cartilage between ribs and sternum)
What are the characteristics of the pain associated with Ankylosing Spondylitis?
Gradual onset Radiates from SI joints to hip/buttocks Worse at night Morning stiffness Relieved by exercise
What is Schober’s test?
A way of measuring the flexibility of a patients back
Reduced to
What is the question mark posture?
Thoracic kyphosis with neck hyperextension
What investigations can be done in a patient with suspected Ankylosing spondylitis?
X ray - changes occur late so usually a clinical diagnosis
Sacroiliitis - Sclerosis, erosions
Vertebrae - Corner erosions, squaring, syndesmophytes (bony proliferations)
Bamboo spine - Calcification of spinal ligaments, periosteal bone formation
Bloods - FBC - anaemia, ESR/CRP, HLA-B27
DEXA scan - bone density
CXR - pulmonary fibrosis
What is the conservative management of Ankylosing Spondylitis?
Exercise
Physiotherapy
What are the medical treatments for Ankylosing Spondylitis?
NSAIDs eg indomethacin
Anti TNF - if severe
Local steroid injections
Bisphosphonates - Bone protection
What is the surgical management of Ankylosing spondylitis?
Hip replacement can reduce pain and improve mobility
