Ankylosing Spondylitis and Fibromyalgia

Question 1

Ankylosing Spondylitis - Definition

Answer 1

Systemic rheumatic disease affecting entire body. Inflammatory arthropathy of axial skeleton.

Question 2

Ankylosing Spondylitis - Cause (3) and Risk Factors (2)

Answer 2

Unclear, genetics, environmental factors.
Men, older age.

Question 3

Ankylosing Spondylitis - Pathogenesis

Answer 3

Progressive fusion of zygapophyseal joints and disc spaces resulting in a stiff, rigid spine with Tx forward posture.
Spine vulnerable to injury -> fractures.
Enthesitis/inflammation of ligaments, tendons and cartilage attachments.
Reactive bone formation.

Question 4

Ankylosing Spondylitis - Signs and Symptoms (6)

Answer 4

• Gradual onset of LBP an stiffness > 3 months.
• Morning stiffness > 1hþ
• Pain and stiffness with rest, gets better with movement.
• Bowel irritation.
• Fatigue, eye inflammation.
• Loss of chest wall expansion (costovertebral ligaments ossified -> kyphosis) -> decreased lung volumes.

Question 5

Ankylosing Spondylitis - Joints commonly involved (5)

Answer 5

Spine, SIJ, heels, hips, shoulder.

Question 6

Ankylosing Spondylitis - Red Flags (2)

Answer 6

Sudden onset of LBP, SIJ or hip pain with no trauma or over-use, non-mechanical cause of back pain.
Signs and symptoms of systemic disease (fever, fatigue, respiratory)

Question 7

Ankylosing Spondylitis - Assessments (3) and Outcome Measures (3)

Answer 7

Assess ROM and strength of spine and peripheral joints (schober test).
Chest expansion
Hip flexion contractions - hip deformities - IR ROM.
- BASMI: severity of AS
- BASFI: functional index
- BASDAI: activity index (severity of symptoms)

Question 8

Ankylosing Spondylitis - Exercise Prescription (4)

Answer 8

Avoid high impact/contact sports, high velocity trunk flexion/rotation -> high risk of fracture.
- Spinal mobility and peripheral joint mobility!*
- Stretching, strength, cardiopulmonary, functional.
- Hydrotherapy, modified Pilates and Tai Chi.

Question 9

Fibromyalgia - Definition

Answer 9

Syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness and systemic symptoms.

Question 10

Fibromyalgia - Onset and Etiology (4)

Answer 10

20-55 years old, female > male.
Multifactorial etiology: CNS, ANS, genetics, neuroendocrine dysfunction.

Question 11

Fibromyalgia - Risk Factors (5)

Answer 11

RA!* or Lupus
Age
Smoking
Stress and anxiety

Question 12

Fibromyalgia - Pathogenesis

Answer 12

Malfunction of CNS.
Central sensitization -> greater perception of pain + ineffective pain inhibition. Low pain threshold.
Abnormal pain modulation -> hyperalgesia and allodynia.

Question 13

Fibromyalgia - Signs and Symptoms (7)

Answer 13

• Muscle pain!
• Tender points bilaterally
• Diffuse pain
• Sleep disturbance, fatigue.
• Diaphragm significantly affected (accessory muscles take over).
• Wind up response (central sensitization)
• High level of muscle activity during ADLs.

Question 14

Fibromyalgia - Tender Points (9)

Answer 14

Bilateral
- Occiput
- Low cervical
- Trapezium
- Supraspinatus
- 2nd rib
- Lateral epicondyle (elbow)
- Gluteal
- Greater trochanter
- Knee

Question 15

Fibromyalgia - Management

Answer 15

Multidisciplinary approach, PA 150 min per week, education, self management and coping strategies, exercise.

Question 16

Fibromyalgia - Exercise

Answer 16

• Strength and aerobic: reduce symptoms, improve sleep and function.
• Tai Chi, yoga, Nordic walking, hydrotherapy (pain relief).
  Intensity: gradual progression to moderate intensity for aerobic. Low resistance with 10% increase after 2 weeks without symptom exacerbation for strengthening.