Ankylosing Spondylitis

Question 1

What is it?

Answer 1

-Chronic inflammatory disease of the spine and sacro-iliac joints
- fusion of spine and sacroiliac joints

Question 2

who gets it?

Answer 2

• M:F 3:1
• 20-40yrs

90% are HLA-B27 positive

Question 3

how does it present?

Answer 3

• 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 4

what are the conditions associated with it?

Answer 4

-Anterior uveitis
-Aortitis
-Pulmonary fibrosis
-Amyloidosis

Question 5

what test do you do?

Answer 5

Schober’s test - should extend beyond 20cm

Question 6

how is it investigated?

Answer 6

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 7

first line management?

Answer 7

NSAID & physiotherapy

Question 8

more severe management?

Answer 8

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