Ankylosing Spondylitis

Question 1

What is Ankylosing Spondylitis

Answer 1

Chronic inflammatory disease
Primarily affects the axial skeleton including a sacroiliac joints, intervertebral disc spaces and costovertebral articulations(Pelvic girdle).
Onset usually in third decade of life
Men are three times more likely to develop AS than women

Question 2

Etiology And Pathophysiology

Answer 2

Genetic predisposition
Precise cause is unknown
Inflammation of the joints and adjacent tissues -> cause formation of granulation tissue and dense fibrous scars->lead to joint fusions
Inflammation can affect the eyes, lungs, heart, kidneys and peripheral nervous system

Question 3

Clinical Manifestations

Answer 3

Spine pain, Low back pain, stiffness
Limitation of motion , worse during night and morning
In women, early symptoms may include neck pain
Uveitis (pigmented layer of the eye, middle layer): most common non skeletal symptom
May experience distressing chest pain, sternal/costal cartilage tenderness.

Question 4

Complications

Answer 4

Severe Postural abnormalities and deformity
Altered vision
Aortic insufficiency
Pulmonary fibrosis
Cauda equina syndrome: lower extremity weaknesss, bladder dysfunction
Risk for Spinal fractures (osteoporosis)

Question 5

Diagnostics

Answer 5

X-rays
MRI ( early cartilage abnormalities)
CT scans
Laboratory testing not specific , but elevated ESR and mild anemia can be seen
Presence of HLA-B27 antigen

Question 6

Treatment

Answer 6

Main goal is to maintain maximum skeletal mobility
Decreased pain and inflammation
Heat application to relieve local symptoms
NSAIDS
Salicyclates
Sulfasalazine or methotrexate may help peripheral joint disease
Local corticosteroids injections

Etanercept: binds to TNF and inhibits its action
Reduces active inflammation and impove spinal mobility
Additional TNF inhibitors: Infliximab, adalimumab, golimumab.
Exercise once pain and stiffness is managed
Stretches, hydrotherpy
Surgery for severe deformities and mobility impairment

Question 7

Nursing Management

Answer 7

Patient education on home management program.
ROM assessment (chest expansion)-Deep breathing exercises
Smoking cessation
Physical therapy: strengthening and stretching exercises to preserve ROM
Discourage excessive physical exertion

Proper positioning at rest
Firm mattress, sleep on back with flat pillow
Avoid positions that encourage flexion deformity
Postural training, avoid spinal flexion , heavy lifting, prolonged walking, standing or sitting.
Encourage sports that facilitate stretching such as swimming and racquet games.
Deep breathing exercises
Family teaching