Rheumatology 5 - Ankylosing Spondylitis

Question 1

ank spond presentation

Answer 1

seronegative spondyloarthropathy HLAB27

young male, gradual monthly onset

low back pain
stiffness
sacroiliac pain

takes 30 mins + to get less stiff in the morning

flaring periods

Question 2

key complication of ank spond

Answer 2

vertebral fractures

Question 3

key x ray findings in ank spond x6

Answer 3

bamboo spine
squaring of vertebral body
subchondral sclerosis 
fusion of joints
syndesmophytes

look at xray

Question 4

associataions with ank spond

Answer 4

many

e.g.

fibrosis, IBD, enthesitis, chest pain, aortitis

Question 5

what part of the spinal exam is key with ank spond?

Answer 5

Schober’s test

find L5
draw line 10cm above, 5cm below

if less than 20cm stretch in lumbar flexion, suspect restricted movement

Question 6

investigations x 4 for ank spond

Answer 6

CRP ESR
HLA B27 test
x ray spine, sacrum
MRI - bone marrow oedema early sign

Question 7

managing ank spond

Answer 7

NSAIDs (try a new one if no improv after 4 weeks)
steroids in flares
anti TNF
secukinumab last line

physio
don’t smoke