Ankylosing Spondylitis

Question 1

What is ankylosing spondylitis?

Answer 1

Inflammation condition mainly affecting the spine.

Question 2

What is this a presentation of:
Young adult with progressive back pain and stiffness, worst with rest and improves with movement, worst at night and in the morning, takes 30 mins for pain to improve?

Answer 2

Ankylosing spondylitis

Question 3

What group of conditions does ankylosing spondylitis belong to and what is the related gene?

Answer 3

Seronegative spondyloarthropathy

HLA B27 gene

Question 4

Which are the key joints affected in ankylosing spondylitis?

Answer 4

Sacroiliac joints and vertebral column joint.

Question 5

What is the key complication of ankylosing spondylitis?

Answer 5

Vertebral fractures

Question 6

Which inflammation conditions is ankylosing spondylitis associated with?

Answer 6

Enthesitis, dactylitis, aortitis, anterior uveitis, IBS.

Question 7

What non-inflammatory conditions is ankylosing spondylitis associated with?

Answer 7

Anaemia, heart block, restrictive lung disease, pulmonary fibrosis.

Question 8

What are the steps of Schober’s test, what is an abnormal finding, and what is it used for?

Answer 8

1. Stand straight, find L5, mark 10cm above and 5cm below, bend forwards, measure the distance.
2. Less than 20cm - restricted lumbar movement
3. Assesses mobility of the spine.

Question 9

What investigations would you carry out for suspected ankylosing spondylitis?

Answer 9

1. Inflammatory markers
2. HLA B27 genetic test
3. X-ray of spine and sacrum
4. MRI of spine

Question 10

What would and MRI of the spine show in ankylosing spondylitis?

Answer 10

Bone marrow oedema early in disease before X-ray changes.

Question 11

What are the x-ray changes in ankylosing spondylitis?

Answer 11

1. ‘Bamboo spine’ - fusion of spine and sacroiliac joints
2. Squaring of vertebral bodies
3. Subchondral sclerosis and erosions
4. Syndesmophytes - ligaments inserting into bone
5. Ossification of ligaments/discs/joints

Question 12

What medications are used in ankylosing spondylitis?

Answer 12

1. NSAIDs - for pain
2. Steroids - symptom control (PO/IM/joint injections)
3. Anti-TNF medications
4. Secukinumab - monoclonal Ab against IL-17

Question 13

What is the additional management (non-pharmaceutical) of ankylosing spondylitis?

Answer 13

Physiotherapy, exercise, avoid smoking, bisphosphonates, treat complications, surgery for spine deformities.