Ankylosing Spondylitis Flashcards
What sort of spondyloarthropathy is Ankylosing Spondylitis?
An HLA-B27 spondyloarthropathy
What gender does it usually present in?
Males
What age do males usually get Ankylosing Spondylitis?
20-30 years old
How does Ankylosing Spondylitis usually develop?
- A young man who presents with lower back pain and stiffness of insidious onset
- Stiffness is usually worse in the morning and improves with exercise
- The patient may experience pain at night which improves on getting up
What are some other features associated with Ankylosing Spondylitis?
HINT “Think all A’s”
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis
- And cauda equina syndrome
- Peripheral arthritis (25%, more common if female)
What investigations should be done in Ankylosing Spondylitis?
- ESR & CRP - usually raised
- Sacroiliac Join X-ray - Most useful for establishing the diagnosis.
What X-ray changes are seen in the sacroiliac?
- Sacroilitis: subchondral erosions, sclerosis
- Squaring of lumbar vertebrae
- ‘Bamboo spine’ (late & uncommon)
- Syndesmophytes: due to ossification of outer fibers of annulus fibrosus
What chest x-ray changes can be seen in ankylosing spondylitis?
Apical Fibrosis
What would spirometry show in ankylosing spondylitis & why?
Restrictive lung disease
(Due Kyphosis, Pulmonary fibrosis and ankylosis of the costovertebral joints)
What is the management of Ankylosing Spondylitis?
- Encourage regular exercise
- Physiotherapy
- NSAIDs are first line
- DMARDs - only useful if peripheral joint involvement.
- ANTI-TNF (Etanercept & Adalimumab)- useful if high disease activity despite conventional treatments.
Should you test for HLA-B27 in primary care?
NICE CKS recommend not testing for HLA-B27 in primary care
Does ESR/CRP correlate or not correlate with disease activity?
It correlates with disease activity.
