Ankylosing spondylitis Flashcards
What are the spondyloarthritides?
- Ankylosing spondylitis
- Axial spondyloarthropathy
- Reactive arthritis
- Psoriatic arthritis
- Enteric arthropathy
What are the shared clinical features of sponyloarthritides?
- HLA-B27 association
- Seronegativity (negative RF)
- Axial arthritis: spine and SI joints
- Asymmetrical large-join oligoarthritis
- Enthesitis
- Dactylitis
- Extra-articular manifestations
What is enthesitis?
- Inflammation of the site of insertion of tendon or ligament into bone
- eg plantar fascitis, achilles tendonitis
What is dactylitis?
- Inflammation of the entire digit (Sausage digit)
- Due to soft tissue oedema + joint inflammation
Descrbe Ankylosing spondylitis?
- Presence of sacroilitis on x-ray
- other structural changes which may progress to spine fusion
- Mostly males
- HLA-B27 associated
Read these case presentations of AS
Risk factors for the development of AS?
- HLA-B27
- Positive family history
- Klebsiella pneumoniae
Describe some of the signs and symptoms of AS?
- Progressive spinal inflammation
- Vertebral osteoporosis
- Question mark posture
- Extra-articular features
What are some of the extra-articular manifestations of axial spondyloarthritis and ankyklosing spondylitis?
- Anaemia, fatigue
- Anterior uveitis
- Prostatitis, sterile urethritis
- Osteoporosis
- Inflammatory bowel disease
What is used to diagnose AS?
- Modified new york criteria
- X-ray evidence of sacroilitis
- 1 feature on history or examination
Describe the modified new york criteria for AS?
Describe the tests for AS?
- MRI
- X-ray
- FBC (normocytic anaemia), raised ESR, CRP
- HLA-B27 testing
- DXA scanning
Describe the management of AS?
- Physiotherapy
- 1st: NSAIDs
- Relieve symptoms within 48hr
- 2nd: TNF-a blockers (etanercept, adalimumab)
- Bisphosphonates may reduced fracture risk
What is pictured here?
Progression to question mark posture in AS
Benefits of MRI in AS?
- More sensitive for detection of early sacroilitis
- Can detect inflammatory changes
Signs of AS on X-ray?
- Sacroilitis
- Widening of SI joint space
- Joint space narrowing and sclerosis occurs later
- Syndesmophytes and squaring of vertebral bodies
- Bamboo spine occurs in later stages
What causes bamboo spine to occur in AS?
- Ossiciation of the anterior longitudinal ligament
- Facet joint fusion
What are the aims for AS management?
- Relieve pain and sitffness
- Maintain range of skeletal movement
- Avoid development of deformities
Describe the management of AS?
- Long-acting NSAID
- Naproxen
- Mobilising exercises
- Intra-articular hydrocortisone injections
- Sulfaslazine
- Infliximab
- Spinal osteotomy can correct posture
Describe the relation of AS to pulmonary function tests?
- Restrictive picture on spirometry
- Kyphoscoliosis
Describe a specific test from spine examin which would indicate AS?
- Schober’s test
- Reduced forward flexion
When should a patient be started on TNF-alpha blocker therapy?
When 2 different NSAIDs have failed and they meet the criteria for adult disease on 2 occassions, 12 weeks apart
