Quiz 3- Ankylosing spondylitis

Question 1

Key Points:

1. Insidious onset of low-back pain in?
2. HLA-B27
3. Primarily affects what regions?
4. Inflammation over time leads to what?
5. Dysbiosis is almost alway what?
6. Can also be associated with ??

Answer 1

1. Low-back pain in young adults. (in MEN)
2. 90% HLA-B27 positive.
3. Primarily affects the spine and SI joint
4. Inflammation over time leads to new bone formation and ankyloses of the spine.
5. Dysbiosis is almost always present in AS.
6. Can also be associated with psoriasis and chronic inflammatory bowel disease.

Question 2

Epidemiology/Etiology:

1. Genetic
2. Peak age?
3. Cause of AS?

Answer 2

1. Genetic – risk increases 16x with a first-degree relative with AS and 20x if they are HLA-B27 positive- Only 5% develop AS- Not diagnosis
2. Peak age is between 15-35 years.
3. Cause of AS is unclear, but immune dysregulation is common combined with genetic risk factors.

Question 3

Clinical Features:

1. Most common pain?
2. Age of onset < ?
3. Pain improves with?; no improvement with?
4. Pain lasts > ?
5. Pain worse when?

Answer 3

• Inflammatory back pain is most common
• Age of onset < 40 years; Insidious onset
• Pain improves with exercise; no improvement with rest
• Pain lasts > 30 minutes
• Pain worse at night

Question 4

•Extraarticular conditions (monitor):

Answer 4

uveitis

Question 5

AS Diagnostic Criteria:

***Help to confirm a diagnosis

Answer 5

Diagnosis can be made with an AP plain radiograph of the SI joints which REQUIRES:
•Presence of grade 2 bilateral or grade 3 unilateral sacroiliitis
PLUS 1 or more of the following:
•Inflammatory low back pain for > 3 months that improves with exercise and does not improve with rest
•Limited lumbar spine motion in sagittal and frontal planes.
•Decreased chest expansion for age and sex.
•**HLA-B27 can help to confirm a diagnosis

Question 6

AS Diagnostic Testing:

Answer 6

• Serum IgA – usually elevated

* HLA-B27 – elevated in 90% of those with AS.

Question 7

Conventional Medications:

Answer 7

• NSAIDs – first line of treatment

* In most patients they are the only medication required.

Question 8

Nutritional Supplementation: 5

Answer 8

•Selenium – 200 – 400mcg/day
•Zinc – 30mg per day
•Proteolytic/pancreatic enzymes
•Glucosamine sulfate – 1500mg qd – may help improve motility
•Curcumin – 3-6g per day
Vitamin D

Question 9

Botanical Medicine: 4

Answer 9

• Uncaria tomentosa – Cat’s claw
• Harpagophytum procumbens – devil’s claw
• Boswellia serrata
• Topical capsicum

Question 10

Dysbiosis: 6

Answer 10

All patients with a spondyloarthropathy should be assessed for dysbiosis (50-60% of those with AS have macroscopic signs of GI inflammation)

• Berberine: 500mg BID
• Oregano Oil: 300mg BID
• Artemisia annua: 100mg BID
• Probiotics: 50 billion organisms daily
• L-Glutamine: 3g TID
• DGL:

Question 11

Lifestyle Considerations: 5

Answer 11

• Smoking cessation
• Exercise!! (Daily & consistent – 8 wks see improvement)
• Range of motion stretching daily
• Postural training
• Physical therapy

Question 12

Dietary Considerations:

Answer 12

• Anti-inflammatory diet

* Low red meat, dairy, saturated fats, high glycemic foods