Ankylosing spondylitis

Question 1

What?

Answer 1

Chronic inflammatory disease of spine & sacro- iliac joints

Can lead to eventual fusion of intervertebral & SI joints

Question 2

Who?

Answer 2

Males> women

20-40 years

Question 3

Presentation?

Answer 3

Back pain (SI joints)
Enthesitis
Peripheral arthritis
Spinal morning stiffness improves with exercise
"Questions mark spine"

Question 4

Question mark spine?

Answer 4

Loss of lumbar lordosis and increases thoracic kyphosis

Question 5

Extra- articular features?

Answer 5

Anterior uveitis
CV involvement
Pulmonary involvement 
Asymptomatic enteric mucosal inflammation
Neurological involvement
Amyloidosis

Question 6

“A” disease?

Answer 6

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)

Question 7

Diagnosis - examination?

Answer 7

Tragus/ occiput to wall
Chest expansion
Schober test

Question 8

Investigations?

Answer 8

Bloods (inflammatory parameters, HLA-B27 positive (often))
Xrays
MRI

Question 9

X- ray changes?

Answer 9

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

Question 10

MRI findings?

Answer 10

Earlier features
Bone marrow oedema
Enthesitis of spinal ligaments
Not needed for diagnosis if Xray confirms

Question 11

Classification?

Answer 11

ASAS classification

Question 12

Management?

Answer 12

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)