Ankylosing Spondylitis

Question 1

What is ankylosing spondylitis.

Answer 1

Chronic seronegative disease of unknown aetiology, resulting in inflammation of multiple articular and para-articular structures - bony ankylosis.

Question 2

What is ankylosing spondylitis associated with.

Answer 2

HLA-B27.

Question 3

In what percentage of patients with ankylosing spondylitis is there an associated with HLA-B27.

Answer 3

Up to 95% of patients.

Question 4

When does onset of ankylosing spondylitis usually occur.

Answer 4

Onset occurs in late teens/early adulthood.

Question 5

Who is most affected with ankylosing spondylitis.

Answer 5

Men tend to be more affected than women.

Question 6

What are the symptoms of ankylosing spondylitis. (6)

Answer 6

Gradual onset lower back pain.
Early morning spinal stiffness (relieved by exercise).
Enthesitis.
Anterior uveitis.
Pain radiated from sacroiliac joints to hips/buttocks.
Pain usually improves towards the end of the day.

Question 7

What are the physical signs of ankylosing spondylitis. (7)

Answer 7

Tenderness over the sacroiliac joint. 
Decreased anterior flexion of the lumbar spine. 
Thoracic spinal fusion. 
Decreased lateral spinal flexion. 
Decreased chest expansion. 
Aortic regurgitation. 
Apical lung fibrosis.

Question 8

What is seen in the blood results of a patient with ankylosing spondylitis. (3)

Answer 8

Chronic anaemia.
RhF negative.
Raised ESR.

Question 9

What is seen on the Xray of a patient with ankylosing spondylitis. (7)

Answer 9

Sacroiliitis. 
Juxta-articular sclerosis. 
Syndesmophyte formation.
Marginal erosion.
Fusion of adjacent vertebra (bamboo spine). 
Disk calcification. 
Pseudoarthrosis.

Question 10

What joints are most often affected in ankylosing spndoylitis. (2)

Answer 10

Spine.

Sacro-iliac joints.

Question 11

What is the prevalence of ankylosing spondylitis.

Answer 11

0.25-1%.

Question 12

What is the ratio of men :women with ankylosing spondylitis. (2)

Answer 12

Men present earlier than women:

6: 1 at 16 years.
2: 1 at 30 years.

Question 13

What is the typical disease progression in ankylosing spondylitis. (3)

Answer 13

Kyphosis.
Neck hyperextension (? posture).
Spino-cranial ankyloses.

Question 14

What enthesitis are most commonly seen in ankylosing spondylitis. (4)

Answer 14

Achilles tendonitis.
Planter fasciitis.
At the tibial and ischial tuberosities.
At the iliac crests.

Question 15

What is the cause of anterior mechanical chest pain in ankylosing spondylitis.

Answer 15

Due to chostochondritis. (fatigue may be a symptom).

Question 16

What symptom occurs in 33% of patients.

Answer 16

Acute irits.

Question 17

What other conditions is ankylosing spondylitis associated with. (3)

Answer 17

Osteoporosis.
Aortic valve incompetence.
Pulmonary apical fibrosis.