Ankylosing Spondylitis Flashcards
What is ankylosing spondylitis?
Inflammatory condition affecting the spine, causing progressive stiffness and pain. It is a seronegative spondyloarthropathy.
What is Ankylosing Spondylitis associated with?
- HLA B27 gene
- Associated with reactive and psoriatic arthritis (all are seronegative spondyloarthropathies)
Which joints are affected in AS?
- Sacroiliac joints
- Vertebral column
What finding in the spine is seen on XR?
- ‘Bamboo Spine’ due to fusion of the vertebrae and sacroiliac joints
How many AS patients have the HLA B27 gene? How many people with the HLA B27 gene will develop AS?
- 90% have the gene
- 2% of people with the gene will get Ankylosing Spondylitis/20% if has a first degree relative
How does Ankylosing Spondylitis typically present?
- Symptoms develop over 3+ months
- Lower back pain and stiffness
- Sacroiliac pain in the buttock region
- Symptoms fluctuate/flare and regress
Describe the character of the pain.
- Pain is worse on waking and when going to sleep
- Takes around 30 minutes for stiffness to improve and will improve with activity
What is a key complication of ankylosing spondylitis?
Vertebral fractures
What other organ systems/conditions can Ankylosing Spondylitis affect/cause?
Constitutional- weight loss, fatigue
MSK- costovertebral/sternal joint pain, dactylitis
CVS- anaemia, heart block (heart fibrosis), aortitis
Resp- pulmonary fibrosis, restrictive lung disease
GI- IBD associated with AS
What examination test is important for Ankylosing Spondylitis?
Schober’s Test
What is Schober’s Test?
- Patient stands straight
- Find L5, mark a point 10cm above and 5cm below
- As the patient bends forwards, the distance should extend from 15cm to at least 20cm
- <20cm indicates restricted lumbar movement
What bloods would you do?
- HLA B27 genetic testing
- CRP, ESR
- Full profile (anaemia, organ function)
What imaging is useful?
XR- spine and sacrum
MRI- bone marrow oedema in early stages (before the XR changes)
What XR changes can be seen in the spine?
Bamboo Spine:
- Squaring of the vertebral bodies
- Subchondral sclerosis and erosions
- Ossified ligaments, discs and joints (turned to bone)
- Fusion of facet, sacroiliac and costovertebral joints)
How is it medically managed?
Analgesia- NSAIDs
Steroids during flares
Anti-TNF- etanercept and MABs e.g. infliximab, adalimumab
