Ankylosing Spondylitis

Question 1

What are the two key joints affected by ankylosing spondylitis?

Answer 1

Sacroiliac

Intervertebral

Question 2

Appearance on X ray after fusion of spine

Answer 2

Bamboo spine

Question 3

Ankylosing spondylitis pain is usually worse in ___ and improves with ___

Answer 3

Morning

Activity

Question 4

How long should it take for ankylosing spondylitis stiffness to improve with activity?

Answer 4

30 mins

Question 5

What other conditions is ankylosing spondylitis associated with (any 5)

Answer 5

Weight loss and fatigue 
Chest pain
Enthesitis
Dactylitis 
Anaemia
Anterior uveitis
Aortitis
Heart block
Restrictive lung disease 
Pulmonary fibrosis 
IBD

Question 6

What is the test used to assess mobility of spine in ankylosing spondylitis and at what vertebral level is the test done at? What distance between the vertebrae should there be when bending over?

Answer 6

Schober’s test

L5

Over 20cm

Question 7

What investigations are done in ankylosing spondylitis? (4)

Answer 7

CRP and ESR

HLA B27 genetic test

X ray of spine and sacrum (less sensitive in early disease)

MRI whole spine in early disease

Question 8

What are the meds used in ankylosing spondylitis? (4)

Answer 8

NSAIDS

Steroids

Anti TNF meds

Secukinumab (If NSAIDS and anti-TNF don’t work)

Question 9

What is the non pharmaceutical management of ankylosing spondylitis? (Any 3)

Answer 9

Physio

Exercise and mobilisation

Stop smoking

Bisphosphonates for osteoporosis

Treat complications

Surgery