Ankylosing spondylitis Flashcards
Describe the pathophysiology
The S shape of the spine allows for forwards and backwards movement
Inflammation of the joints in the spine beginning with the sacroiliac joint leads to their fusion
Fusion of these joints reduces this motion (bamboo spine appearance also results)
What is found if you test for rheumatoid factor in ankylosing spondylitis?
The patient will be seronegative for RF
What demographics are most commonly affected?
Male
Aged 15-45
What are the clinical features of ankylosing spondylitis and when do they manifest?
Back pain in episodes of inflammation
Pain in buttock associated with lower back pain and stiffness - worse in the morning and relieved by exercise
Early - retention of lumbar lordosis during spinal flexion
Late - paraspinal muscle wasting
What are the 5 diagnostic criteria? How many are needed for a diagnosis?
Age of onset <45 years Insidious onset Improvement of back pain with exercise No improvement of back pain with rest Pain at night with no improvement on getting up
What investigations must be done?
Bloods - CRP, ESR
Imaging - x-ray, MRI
Genetics - HLA - B27 testing
What would be found on x-ray?
Erosions of the medial and lateral cortical margins of both SI joints
Syndesmophytes
Bamboo spine
What would be found on MRI?
Demonstrates sacroiliitis and enthesitis before it is seen on x-rays
Why do we test for HLA-B27?
All seronegative spondyloarthropathies are HLA-B27 associated
What are the components of management of ankylosing spondylitis?
BASDAI scoring Morning preventative exercises NSAIDs DMARDs TNF inhibitors PDE4 inhibitor
What is the purpose of BASDAI scoring in management of ankylosing spondylitis?
Assessing disease severity
What is the purpose of morning preventative exercises/
Prevents the formation of syndesmophytes
Maintains spinal mobility, posture and chest expansion
Failure to do morning exercises can lead to irreversible dorsal kyphosis
What is the purpose of NSAIDs?
Controlling the pain
What is the purpose of DMARDs?
Affects the peripheral joint complications, not spinal
What is the purpose of TNF inhibitors?
Affect both spinal and peripheral joint symptoms
