Rheumatology: Ankylosing Spondylitis

Question 1

Discuss the pathophysiology of ankylosing spondylitis

Answer 1

Chronic inflammatory disease of the spine and sacroiliac joints

Interaction between raised serum levels of IgA, acute phase reactants of inflammation, and the HLA-B27 gene

Entheseal fibrocartilage is the major target of the immune system and inflammation in AS

Question 2

What are the symptoms and signs of ankylosing spondylitis?

Answer 2

Gradual onset lower back pain

Pain worse at night

Spinal morning stiffness

Pain relieved by exercise

Pain radiates to hips and buttocks

Progressive loss of spinal movement

Decreased thoracic expansion

Enthesitis = achilles tendonitis, plantar fasciitis at the tibial and ischial tuberosities and iliac crests

Acute iritis

Osteoporosis

Question 3

How should ankylosing spondylitis be investigated?

Answer 3

90% HLA B27 +ve

MRI

X-ray = sacroiliitis (irregularities, erosions, sclerosis), vertebral syndesmophytes, bony proliferations between ligaments and vertebrae

Bamboo spine = calcifications of ligaments with ankylosis

Bloods = FBC (normocytic anaemia), increased ESR, increased CRP

Question 4

How is ankylosing spondylitis managed?

Answer 4

Exercise not rest for back pain

Physiotherapy

NSAIDs

TNF-alpha blockers = etanercept

Local steroid injections

Surgery = hip replacement, spine osteotomy

Question 5

What are the possible complications from ankylosing spondylitis?

Answer 5

Eyes = sensitivity to light, blurred vision, blindness

Incontinence

Sexual dysfunction