Ankylosing Spondylitis (AS)

Question 1

Important Aspects from the Hx

Answer 1

• Familial Hx: Strong Familial tendency
• Age: Maximum incidence: 15-30 years
• Male (3): Female (1)
• Usually insidious onset of: Lower back ache, joint stiffness, fatigue
• Clinical course characterised by active phases interspersed with remissions. Remissions can be spontaneous; can last weeks, the course caries from patient to patient
• Women often present atypically

Question 2

Manifestations of Mild or early ankylosing spondylitis

Answer 2

Pain
- Unilateral initially
- usually dull and diffuse
- Lower spine and SIJs 
25% of cases have involvement of: hips, knees & shoulders, and occasionally the smaller joints in the hands and feet
Decreased ROM in affected joints
Joint stiffness: occurs after inactivity
Tenderness over spin and SI joints
Systemic manifestations
- mild fever
- general discomfort
- loss of appetite

Question 3

Manifestations in established ankylosing sponylitis

Answer 3

Pain and stiffness may progress to affect other areas of the spine and other joints

• Bilateral pain
• Pain and joint swelling in the shoulders, knees and ankles
• heel pain
• neck pain

Abnormalities due to ossification to paraspinal soft tissues

• Stooped, posture due to dertebral fusion; chornic stooping relieves symptoms
• loss of lx lordosis
• increased Tx kyphosis
• Forward thrust of beck
• Limited expansion of the chest if cost-vertebral joints are affected

Extra-articular manifestations

• Anterior uveitis (iris) (painful, watery, red eyes, blurred vision, photosensitivity)
• Aortic incompetence (in long standing disease)
• Inflammatory bowel disease especially Crohn’s disease and ulcerative colitis
• Respiratory disease
• Malaise
• Fever
• Anorexia and weight loss
• anaemia (pallor)
• Neurological manifestations