Ankylosing spondylitis (and a bit on seronegative spondyloarthropathy)

Question 1

what are seronegative spondyloarthropathies

Answer 1

inflammation of vertebral column negative for rheumatoid factor and ANA

Question 2

what diseases are included in seronegative spondyloarthropathies

Answer 2

ankylosing spondylitis
psoriatic arthritis
reactive arthritis

Question 3

what is ankylosing spondylitis

Answer 3

ankylosing: stiffness of joint bc of adhesion and bone rigidity
spondylitis: inflammation of spine

Question 4

when does ank spond present

Answer 4

late teens to early 30s

Question 5

gene associated with ank spond

Answer 5

HLA b27

Question 6

what joints does ank spond affect

Answer 6

spine and sacroiliacs

Question 7

what sign is shown in the spine on xray

Answer 7

bamboo spine (fusion of veterba

Question 8

pathology in ank spond

Answer 8

• enthesitis (inflammation of where ligament attaches to bone)
• syndesmophyte formation (bone inside ligaments of vertebrae)
• sclerosis of bone
• fusion of bone)
• calcification of ligaments

Question 9

sx ank spond

Answer 9

lower back or buttock pain and stiffness
worse in morning
relieved by exercise
morning stiffness >30 mins

Question 10

lordosis and kyphosis in ank spond

Answer 10

• Loss of lumbar lordosis (less curvy towards belly button)

* Increased kyphosis (of thoracic vertebra?)

Question 11

name of criteria for diagnosing ank spond

Answer 11

New York

Question 12

clinical critiera

Answer 12

• low back pain for more than 3 months, improve by exercise, not reilived by rest
• limitation of lumbar spine motion in both sagittal and frontal planes
• limitation of chest expansion

Question 13

ix ank spond

Answer 13

raised ESR and CRP
X-ray
MRI (more sensitive than xray)

Question 14

radiological criteria dx ank spond

Answer 14

sacroliitis on xray

Question 15

features associated with ank spond

Answer 15

5 As
arthritis
achiles (enthesitis)
anterior uveitis
aortic regurg
amyloidosis (renal)

epicondylitis
psoriasis
IBD

Question 16

what may ank spond be preceded by

Answer 16

infective diarrhoea

STI

Question 17

rx ank spond

Answer 17

PHYSIO!!!!
NSAIDs
anti TNF alpha (adalimumab and etanercept) if NSAIDs don’t work

Question 18

5As of ank spond (extraskeletal features)

Answer 18

acute anterior uveitis
aortic incompetence
apical lung fibrosis
amyloidosis
achilles enthesis

Question 19

classically when does back pain wake pt

Answer 19

second half of night

Question 20

what is the schober test

Answer 20

-make mark at L5 level when pt is standing
-make 2 points 5cm below and 10cm above this point (total 15cm)
-ask pt to touch toes
-if distance does not increase to >20cm, test is +ve
shows restriction in lumbar flexion

Question 21

types of enthesitis

Answer 21

tennis/golfers elbow
achiles tendonitis
plantar fascitis (extremely painful, remember GP pt)