Ankylosing Spondylitis Flashcards
What is it?
Seronegative spondyloarthropathy group [PEAR] of conditions relating to the HLA B27 gene
Clinical Features
- typically a young man who presents with lower back pain and stiffness of insidious onset
- stiffness is usually worse in the morning and improves with exercise
- the patient may experience pain at night which improves on getting up
Findings on clinical examination
reduced lateral flexion
reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below L5 / dimples of Venus. The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
reduced chest expansion
Diagnosis
Inflammatory markers (CRP and ESR) may rise with disease activity
HLA B27 genetic test
Xray of the spine and sacrum
MRI of the spine can show bone marrow oedema early in the disease before there are any xray changes
X-ray findings
“Bamboo spine” is the typical exam description o.
Xray images in ankylosing spondylitis can show:
- Squaring of the vertebral bodies
- Subchondral sclerosis and erosions
- Syndesmophytes are areas of bone growth where the ligaments insert into the bone. They occur related to the ligaments supporting the intervertebral joints.
- Ossification of the ligaments, discs and joints. This is where these structures turn to bone.
- Fusion of the facet, sacroiliac and costovertebral joints
Management
NSAIDs first line often prescribed with a protein pump inhibitor
Disease- modifying-anti-rheumatic- drugs (DMARDs) such as sulfasalazine and methotrexate are more useful in patients with enthesitis than axial symptoms, so are given in addition to analgesia in patients with concomitant peripheral disease.
Local steroid injections can be used as an adjunct
Patients who have failed to control symptoms with NSAIDs/ have severe disease may be offered TNF-alpha inhibitors such as Infliximab.
