Ankylosing Spondylitis (AS)

Question 1

Where does it affect? - 2

Answer 1

Spine and sacroiliac joints

Question 2

What sex presents earlier?

Answer 2

Men

Question 3

What does HLA B27 stand for?

What does it mean to be HLA B27 +ve?

Diseases associated with it are:

• AS
• Psoriatic A
• Reactive A
• Enteric arthropathy
• Acute anterior uveitis

Answer 3

Human leukocyte antigen B27

A positive result means HLA-B27 was found in your blood.

Question 4

Under what age do they usually occur?

Answer 4

Under 30 yrs old

Question 5

Presentation:

Does it have a rapid or gradual onset?

Where do they get pain and stiffness primarily and where does the pain radiate to?

What time of day does it tend to happen?

What happens over time leading to reduced thoracic expansion?

Later features:

• They have a question mark posture. Why does this happen? - 2
• What other bone diseases may occur?

Answer 5

Gradual insidious onset

Low back and sacroiliac joints

Buttocks

Morning - it may wake them up and lasts hours

Reduced spinal movement

Due to kyphosis and neck hyperextension

Osteoporosis
Osteoarthritis

Question 6

Presentation:

Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

This may happen in AS.

• What is swelling of the finger called?
• What is the plantar fasciitis?
• They may get inflammation of the Achilles tendon. What is this called?
• What may the enthesitis cause in the chest?

Answer 6

Dactylitis

Plantar fasciitis is an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis can cause intense heel pain.

Achilles tendonitis

Costochondritis

Question 7

Extra-articular manifestations:

It is described as the 5 A’s. What are they?

• Eyes
• GI
• Lungs
• Heart
• Protein buildup

Answer 7

Anterior uveitis 
Autoimmune bowel disease 
Apical lung fibrosis 
Aortic regurgitation 
Amyloidosis

Question 8

Investigations:

XR:

• What is seen in early disease?
• The fusion of the spine is found in later disease. How is this described?

What imaging can be used which is more sensitive and can show bone marrow oedema?

What is done to look for osteoporosis?

What can be tested for specifically which can help support a diagnosis of AS?

Answer 8

Sacroiliitis:

• Sclerosis
• Erosions
• Enthesitis

Bamboo spine

MRI

DEXA

HLA B27

Question 9

Management:

Lifestyle - 2

Medical:

• What pain relief is given?
• What biological agents can be used in severe disease?
• What can be given for osteoporosis?

Surgical:
- A vertebral osteotomy is used. What is it?

Answer 9

Exercise and physio - to maintain posture and mobility

NSAIDs + PPI
Steroid injections

TNF alpha-blockers

Biphosphonates

Surgery is the last resort for spinal deformities. Spinal osteotomy is an umbrella term for techniques used by spinal surgeons to correct spinal deformity. They can be performed on pediatric or adult patients. The purpose is to establish normal range spinal curvature, relieve pain, and improve quality of life.

Question 10

Enteric arthropathy - what is it?

Answer 10

Enteropathic arthropathy is an umbrella term used to describe various patterns of inflammatory arthritis which may be associated with a range of gastrointestinal (GI) pathologies.

BASICALLY GI ASSOCIATED JOINT DISEASE