ANKYLOSING SPONDYLITIS Flashcards
Define ankylosing spondylitis.
Chronic systemic inflammatory disease of the spine and sacro-iliac joints, which eventually leads to fusion of the spinal vertebra.
Are males or females more affected by ankylosing spondylitis and what is the ratio?
Females
2:1
Are northern Europeans or Afro-Caribbeans more susceptible to ankylosing spondylitis?
Northern Europeans
What is the only known risk factor for ankylosing spondylitis?
HLA-B27 positive
What percentage of people with ankylosing spondylitis are HLA-B27 positive?
90%
What are the main two cytokines involved in ankylosing spondylitis?
TNFα
IL-1
How might someone with suspected ankylosing spondylitis present? (Name 5 symptoms)
Lumbar back pain Worst at night Morning stiffness Relieved during exercise Pain radiating from sacro-iliac joints to hips and buttocks Stooping Pain in tendons such as Achilles tendon Eye pain Problems breathing (comes much later)
On examination, what signs might a patient with suspected ankylosing spondylitis display?
Signs of enthesitis Uveitis s test Loss of spinal movement Occiput-to-wall test shows kyphosis Neck hyperextension
What tests would you do to confirm a diagnosis of ankylosing spondylitis?
X-ray
MRI
Blood tests
What might a blood test show in someone with ankylosing spondylitis?
Normocytic anaemia
Raised ESR
Raised CRP
HLA-B27 positive
What might you see on a X-ray of someone with ankylosing spondylitis?
Sacroiliitis Erosions Sclerosis Syndesmophytes Bony proliferations due to enthesitis Ankylosis Bamboo spine (later stage)
What causes bamboo spine?
Ossification of outer fibers of fibrous ring of inter-vertebral disk, leading to development of syndesmophytes.
What is enthesitis?
Inflammation at the site of insertion of ligaments and tendons into bone. Common tendon affected is the Achilles.
What group of diseases does ankylosing spondylitis fall under?
Seronegative Spondyloarthropathies
What makes seronegative spondyloarthropathies seronegative?
A lack of rheumatoid factor
Why is there a lag time between the onset of ankylosing spondylitis and diagnosis?
Because the signs and symptoms are so unspecific.
What is the average lag time between onset of ankylosing spondylitis and diagnosis?
8.5 to 11.4 years
What are the serious complications of ankylosing spondylitis?
Osteoporosis - fracture as a result of minor trauma
What might an MRI scan show you in a patient with ankylosing spondylitis?
Sacroiliitis Erosions Sclerosis Syndesmophytes Bony proliferations due to enthesitis Ankylosis Bamboo spine (later stage) Shiny corner sign
What does shiny corner sign indicate?
Small erosions at superior and inferior endplates with surrounding reactive sclerosis.
What are the management options for someone diagnosed with ankylosing spondylitis?
Exercise (including intense exercise regimes) Physiotherapy - Posture NSAIDs TNFα blockers (Etenercept) Adalimumab Golimumab Local steroid injections DMARDs (more useful if there is an element of peripheral arthritis) Surgery - hip replacement Bisphosphonates
