Inflammatory Spondyloarthropathy - Ankylosing Spondylitis

Question 1

What is Ankylosing Spondylitis?

Answer 1

An inflammatory condition mainly affecting the spine that causes progressive stiffness and pain.

Question 2

What type of condition is Ankylosing Spondylitis?

Answer 2

Seronegative (RF Negative) Spondyloarthropathy (others : Reactive Arthritis, Psoriatic Arthritis).

Question 3

Epidemiology of Ankylosing Spondylitis.

Answer 3

Stereotype : Young Adult Male in Late Teens or 20s.

Question 4

Risk Factors (2).

Answer 4

1. HLA-B27.
2. Family History.

Question 5

Clinical Features of Ankylosing Spondylitis (3).

Answer 5

1. Progressive Lower Back/Sacroiliac Pain (Worse with Rest and Improves with Movement - Worse at Night and Morning).
2. More Than 3 Month Gradual Onset.
3. Progressive Stiffness - takes at least 30 minutes to improve in the morning.

Question 6

Key Joints Affected in Ankylosing Spondylitis (2).

Answer 6

1. Sacroiliac Joints.
2. Joints of the Vertebral Column.

Question 7

Associations of Ankylosing Spondylitis (7).

Answer 7

IBD & 6As :
1. Inflammatory Bowel Disease.
2. Anterior Uveitis.
3. Amyloidosis.
4. Apical Fibrosis.
5. Aortitis & Aortic Regurgitation.
6. Achilles Tendonitis.
7. AV Node Block.

Question 8

Extraspinal Features of Ankylosing Spondylitis (3).

Answer 8

1. Chest Pain/Restrictive Lung Disease (Costovertebral/Costosternal Joints).
2. Enthesitis - Achilles Tendonitis.
3. Dactylitis.

Question 9

What is Enthesitis?

Answer 9

Inflammation of the entheses - tendon/ligament insertion site into bone.

Question 10

Result of Enthesitis (2).

Answer 10

1. Plantar Fasciitis.
2. Achilles Tendonitis.

Question 11

Investigations of Ankylosing Spondylitis (4).

Answer 11

1. Spinal and Sacral X-Ray.
2. Inflammatory Markers.
3. MRI Spine : Bone Marrow Oedema (Early Disease).
4. HLA-B27 Genetic Test.

Question 12

Examination of Ankylosing Spondylitis (2).

Answer 12

1. Reduced Forward Flexion - Schober’s Test : Positive if Increase Less than 20cm.
2. Reduced Lateral Flexion.

Question 13

X-Ray Changes of Ankylosing Spondylitis (6).

Answer 13

1. Bamboo Spine.
2. Squaring of Vertebral Bodies.
3. Subchondral Sclerosis and Erosions.
4. Syndesmophytes.
5. Ossification (Turn to Bone) of Ligaments, Discs and Joints.
6. Fusion of Facet, Sacroiliac and Costovertebral Joints.

Question 14

What are Syndesmophytes?

Answer 14

Areas of bone growth where ligaments insert into bones.

Question 15

Medical Management of Ankylosing Spondylitis (4).

Answer 15

1. NSAIDs (switch after 2-4 weeks of maximum dose).
2. Steroids (flares).
3. Anti-TNF Medications.
4. Secukinumab (after NSAIDs, Anti-TNF).

Question 16

What is Secukinumab?

Answer 16

A monoclonal antibody against IL-17.

Question 17

Non-Medical Management of Ankylosing Spondylitis (5).

Answer 17

1. Physiotherapy, Exercise and Mobilisation.
2. Smoking Cessation.
3. Bisphosphonates (Osteoporosis).
4. Treatment of Complications.
5. Surgery.

Question 18

Complication of Ankylosing Spondylitis.

Answer 18

Vertebral Fractures.