Ankylosing spondylitis Flashcards
seronegative spondyloarthropathies
AS
psoriatic arthritis
enteropathic arthritis
reactive arthritis
gene association
HLA B27
which joints affected?
sacroiliac
axial spine
hallmark clinical feature
inflammatory back pain
inflammatory back pain
insidious onset
worse in morning
improves with exercise
do most patients respond to NSAIDs?
yes
3 main treatment approaches
physiotherapy
NSAIDs
TNF alpha inhibitors
x-ray - spinal fusion
bamboo spine
key diagnostic factors
risk factors
inflammatory back pain
iritis/uveitis
enthesitis
risk factors
HLA-B27
family history
klebsiella pneumoniae
1st investigation
pelvic x-ray
investigations to consider
HLA-B27
MRI
cervical/lumbar x-ray
CRP, ESR
key complication
vertebral fractures
associated symptoms
weight loss, fatigue chest pain dactylitis anaemia restrictive lung disease IBD
What test is done (OSCE)
Schobers
Describe how to do schobers test
L5 vertebra
make point 10cm above and 5cm below
bend forward - less than 20cm
MRI uses
bone marrow oedema before x-ray changes occur
Key x-ray findings
“bamboo spine”
- squaring vertebral bodies
- subchondral sclerosis and erosions
- syndesmophytes
- ossification of ligaments discs and joints
- joint fusion
syndesmophytes
areas of bone growth where ligaments insert into bone
steroids
during flares
oral, im, ia
example of anti-TNF
etanercept
what is used if NSAIDs and anti-TNF not working?
secukinumab - monoclonal ab against IL-17
additional management
stop smoking
physio, exercise and mobilisation
bisphosphonates
surgery - deformities