Ankylosing Spondylitis

Question 1

What is it?

Answer 1

chronic inflammatory disease of the spine and sarco-iliac joints - fusion of spine and sacroiliac joints

Question 2

pathogenesis

Answer 2

chronic inflammatory disease of spine and sarco-iliac joints
eventual fusion of spine and sarcoiliac joints

Question 3

who gets it?

Answer 3

M:F 3:1
20-40yrs
90% are HLA-B27 positive

Question 4

how does it present?

Answer 4

spinal pain
spinal stiffness - morning stiffness is marked
improves with exercise
overtime - loss of spinal movement, ? spine - loss of lumbar lordosis and increased thoracic kyphosis
may also develop knee and hip arthritis

Question 5

what are the conditions associated with it?

Answer 5

anterior uveitis
aortitis
pulmonary fibrosis
amyloidosis

Question 6

what test do you do?

Answer 6

Schober’s test - should extend beyond 20cm

Question 7

how is it investigated?

Answer 7

X-ray 
- sarcoiliac joint - sclerosis, fusion 
- syndesmophytes - bony spurs from vertebral bodies - can bridge the IV disc - fusion = bamboo spine 
MRI = can detect early features 
- bone marrow oedema 
- enthesitis of the spinal ligaments

Question 8

first line management?

Answer 8

NSAID & physiotherapy

Question 9

more severe management?

Answer 9

if more aggressive - anti-TNF inhibitors
DMARDS impact on spinal disease - may be used if there is peripheral joint inflammation
surgery - reserved for
- hip arthritis
- knee arthritis
- kyphoplasty - straighten out the spine - this is high risk and controversial