Ankylosis Spondylitis

Question 1

Aetiology of ASpnd?

Answer 1

HLA-B27 autoimmune disease

Question 2

Who is more affected?

Answer 2

Men early 20s

Question 3

What bones are mainly affected?

Answer 3

Sacrum
Sacroileum
Pelvis

Question 4

Symptoms?

Answer 4

Inflammatory back pain
Limited hip flexion
Achilles tendonitis
Decreased chest expansion
Linked to IBD

Question 5

What causes decreased chest expansion in Aspond?

Answer 5

Calcification

Question 6

When is the pain in Aspond?

Answer 6

At night and rest

Question 7

What is the criteria of symptoms in Aspond and what are they?

Answer 7

NY criteria

• Reduced chest expansion
• Limited hip flexion/extension
• Inflammatory pain

Question 8

What possible severe complication can be caused by Aspond?

Answer 8

Cauda equina

Question 9

What tests can be done? (special tests o/e and investigations?)

Answer 9

X ray

MRI

Schoebers test

Question 10

What is schoebers test?

Answer 10

Measuring the “stretch” of the spine during flexion

• <5cm with Aspond
• > 5cm is normal

Question 11

What may be shown on X ray?

Answer 11

Sacroilitis

Bamboo spine

Question 12

What may be shown on MRI?

Answer 12

Bone marrow oedema

Question 13

What classification method is used in Aspond?

Answer 13

ASAS classification

Question 14

What is the ASAS classification?

Answer 14

Either

Sacroilitis + 1 of the following findings OR
HLA-B27 +ve + 2 of the following findings

Question 15

What are the following findings in the ASAS criteria that are needed for diagnosis?

Answer 15

MSK findings

• Inflammatory back
• +ve schoebers test
• HLA-B27 positive
• Heel enthesitis

Extra-articular

• Uveitis
• IBD
• Dactylitis
• Psoraisis

So Sacroilitis + 1 of these or HLA-B27 + 2

Question 16

Management?

Answer 16

P H Y S I O T H E R A P Y

Pharma

• 1st line = NSAIDs
• 2nd line = DMARDs

Surgery
- Arthroplasty