Ankylosing spondylitis Flashcards
What?
Chronic inflammatory disease of spine & sacro- iliac joints
Can lead to eventual fusion of intervertebral & SI joints
Who?
Males> women
20-40 years
Presentation?
Back pain (SI joints) Enthesitis Peripheral arthritis Spinal morning stiffness improves with exercise "Questions mark spine"
Question mark spine?
Loss of lumbar lordosis and increases thoracic kyphosis
Extra- articular features?
Anterior uveitis CV involvement Pulmonary involvement Asymptomatic enteric mucosal inflammation Neurological involvement Amyloidosis
“A” disease?
Axial Arthritis Anterior Uveitis Aortic Regurgitation Apical fibrosis Amyloidosis/ Ig A Nephropathy Achilles' tendinitis Plantar Fasciitis (inflammation of plantar fascia – part of foot which connects heal bone to toes)
Diagnosis - examination?
Tragus/ occiput to wall
Chest expansion
Schober test
Investigations?
Bloods (inflammatory parameters, HLA-B27 positive (often))
Xrays
MRI
X- ray changes?
Show changes after long time Sacroiliitis Syndesmophytes (bony spurs from vertebral bodies) Sclerosis & fusion of sacroiliac joints Erosions “Bamboo” spine If not had for long, X-ray may be normal
MRI findings?
Earlier features
Bone marrow oedema
Enthesitis of spinal ligaments
Not needed for diagnosis if Xray confirms
Classification?
ASAS classification
Management?
NSAIDs
Physiotherapy
Exercise
Anti- TNF for more aggressive disease (if spinal pain score >4 eligible for this, if first line medication and physiotherapy not worked for 3 months)