Ankylosing Spondylosis

Question 1

Gene Association

Answer 1

HLA-B27

Question 2

Typical Patient

Answer 2

Male, 20-30

Question 3

Presentation

Answer 3

Bilateral buttock Pain
Lower back pain and stiffness
Symptoms worse with rest and at night
Symptoms improve with movement

Question 4

Examination findings

Answer 4

Reduced lumbar lordosis, ROM
Reduced chest expansion
Positive Schober’s Test

Question 5

Investigations

Answer 5

Raised CRP, ESR, PV
X ray Spine & Pelvis
MRI Spine & Pelvis
Genetic Testing

Question 6

Treatment

Answer 6

NSAIDS and Physiotherapy
Anti TNF (Etanercept)
IL17 Inhibitors

Question 7

X- Ray Signs

Answer 7

Sclerosis of vertebrae, SI Joints, Costo-sternal Joints
Fusion of Vertebral Body, SI Joints, Costosternal Joints
Bamboo Spine
Syndesmophytes

Question 8

Complications

Answer 8

Anterior Uveitis
Aorta incompetence
Apical Pulmonary fibrosis
AV Block

Question 9

Joint X-Ray Signs

Answer 9

Loss of joint space
Erosions (Periarticular)
Soft tissue swelling
Subluxation

Question 10

Extra Articular Features

Answer 10

Carpal Tunnel Syndrome
Cord compression
CVS Risk

Pericarditis
Pleural Disease (Effusion)
Pulmonary Disease (Bronchiectasis)

Sjorjens
Splenomegaly (+ Neutropenia = Felty)
Scleritis