Ankylosing Spondylitis

Question 1

Ankylosing Spondylitis Definition

Answer 1

-Chronic seronegative spondyloarthropathy involving axial skeleton

Question 2

Ankylosing Spondylitis Epidemiology

Answer 2

• Peak onset between 20-30 years

- More common in men

Question 3

Ankylosing Spondylitis Genetics

Answer 3

• Strong familial tendency

- HLA-B27 association

Question 4

Ankylosing Spondylitis Presentation

Answer 4

• Subtle in early stages
• Insidious onset
• Systemic features common
• Morning stiffness that improves with activity
• Pain wakes in early hours
• Often tenderness and reduced range of spinal motion
• Question mark posture in advanced stages
• Peripheral arthritis in one third
• Schober’s test
• Atlanto-axial subluxation, apical fibrosis, anterior uveitis, Achilles tendonitis, aortic regurgitation, amyloidosis

Question 5

Ankylosing Spondylitis Extra-Articular Manifestations

Answer 5

• Eye involvement (anterior uveitis)
• CV involvement (Aortitis may lead to regurgitation, fibrosis of conduction system may lead to block)
• Pulmonary involvement (restrictive lung disease may occur in late stages, due to rib involvement, pulmonary fibrosis may also occur)
• Neurological involvement secondary to fractures of fused spine, cauda equina can occur in those with long-standing disease

Question 6

Ankylosing Spondylitis Diagnostic Criteria

Answer 6

• Modified New York Criteria
• Low back pain for more than 3 months
• Limitation of lumbar spine motion
• Limitation of chest expansion
• Radiological features

Question 7

Ankylosing Spondylitis Differentials

Answer 7

• Mechanical back pain
• Inflammatory conditions
• Degenerative conditions

Question 8

Ankylosing Spondylitis Investigations

Answer 8

• Inflammatory markers

- Imaging: bamboo spine

Question 9

Ankylosing Spondylitis Management

Answer 9

• Refer
• Physio
• NSAIDs