Ankylosing spondylitis

Question 1

What is ankylosing spondylitis?

Answer 1

HLA-B27 associated spondyloarthropathy.

Question 2

What is the typical presentation of ankylosing spondylitis?

Answer 2

• males
• Aged 20-30
• lower back pain and stiffness of insidious onset
• stiffness is usually worse in the morning and improves with exercise
• the patient may experience pain at night which improves on getting up

Question 3

What are the clinical finding on examination of a patient with ankylosing spondylitis?

Answer 3

• reduced lateral flexion
• reduced forward flexion
• reduced chest expansion

Question 4

What investigations are done is ankylosing spondylitis is suspsected?

Answer 4

• Plain x-ray of the sacroiliac joints

* If the x-ray is negative: MRI

Question 5

What is the management of ankylosing spondylitis?

Answer 5

• encourage regular exercise such as swimming
• NSAIDs are the first-line treatment
• physiotherapy
• Anti-TNF if persistently high disease activity
• DMARDs if peripheral joint involvement