Ankylosing spondylitis

Question 1

define ankylosing spondylitis?

Answer 1

seronegative inflammatory arthropathy affecting preferentially the axial skeletal and large proximal joints

Question 2

what is ankylosing spondylitis genetic association?

Answer 2

HLA-B27 gene (90%)

- although not useful as healthy people can be positive.

Question 3

what is the epidemiology of ankylosing spondylitis?

Answer 3

• COMMON

* Typical presentation is in males aged 20-30.

Question 4

what are the presenting symptoms of ankylosing spondylitis?

Answer 4

• Insidious onset
• Lower back and sacroiliac pain
• Stiffness is worse in the morning and improves with exercise
• Pain at night causing disturbed sleep

Question 5

what are the signs of ankylosing spondylitis?

Answer 5

• Reduced range of spinal movement
• Tenderness over the sacroiliac joints
• Reduced lateral spinal flexion
• Reduced forward flexion:

Question 6

which test can be used to help make a diagnosis of AS?

Answer 6

Schober’s Test

• 2 fingers placed 10cm apart on the patients back
• patient is asked to bend over
• the distance between the two fingers should increase by >5cm

Question 7

what are the signs of extra articular disease in ankylosing spondylitis?

Answer 7

o	Anterior uveitis  
o	Apical lung fibrosis  
o	Achilles tendinitis  
o	Amyloidosis 
o	Aortic regurgitation

Question 8

what is the best first line investigation for AS?

Answer 8

• Pelvic Radiographs

Question 9

what might be seen on pelvic radiograph?

Answer 9

o Sacroiliitis
o Squaring of the lumbar vertebrae
o Syndesmophytes

Question 10

what might the bloods show?

Answer 10

o ESR/CRP - high