Ankylosing Spondylitis Flashcards
Definition
Chronic inflammatory disease of spine and sacroiliac joints
Definition of ankylosis
Enthesitis between ligaments and vertebrae –> bony proliferations –> fuse with vertebral body above
Which HLA molecule is strongly correlated with AS?
HLA-B27
How many of those with AS are HLA-B27 positive?
88%
How many of those who are HLA-B27 positive develop AS?
6.5%
What percentage heritability is there with AS?
97%
Ratio of men:women affected
6: 1 (@ 16y/o)
2: 1 (@ 30y/o)
Pathophysiology
Inflammation
Erosions
Repair –> “ossification”
Symptoms and signs
Inflammatory back pain --> decreased range of spinal movements Acute iritis/uveitis Enthesitis IBD Psoriasis Fatigue
What are the common forms of enthesitis?
Achilles tendonitis
Plantar fasciitis
What are the typical features of inflammatory back pain?
Low back pain @ night (pt may wake up)
Early morning stiffness
Relieved by exercise and NSAIDs
Starts @ sacroiliac joints –> radiates to buttocks
To what may the symptoms progress to?
Kyphosis
Neck hyperextension
What bone disease are AS pts at an increased risk of getting?
Osteoporosis –> pathological fractures
Useful investigations
X-ray
MRI
What investigation is more sensitive to early inflammatory changes?
MRI
3 management options
Physiotherapy & exercise
NSAIDs
Steroid injections
Why is physiotherapy essential?
Improves and maintains:
Posture
Flexibility
Mobility
NSAIDs…
Improve spinal stiffness and pain @ all disease stages
Indication for intra-articular steroid injections
Localised inflammation
How to treat peripheral disease
DMARDs (e.g. sulfasalazine)
How to treat refractory disease
Anti-TNFalpha (e.g. etanercept)
