Ankylosing Spondylitis Flashcards
(34 cards)
What type of disease in ankylosing spondylitis (AS)?
seronegative spondyloarthropathy
What other diseases are part of the Group of Sponylorarthritides?
- Psoriatic arthritis
- Enteropathic arthritis
- Reactive arthritis
What gene is AS associated with?
HLA-B27
What is AS?
chronic progressive inflammatory arthropathy lead to radiological change in spine and sacroiliac joints
What are causes of AS?
- HLA-B27 gene: in 90%
- FHx
- Male
- ERAP-1 and IL-23R gene
What is classic epid of AS?
- Age of onset <40 (late teens and early 20s) years and back pain lasting >3 months
- Male
- Prevelance: 0.25-1%
What are classic symptoms and signs of AS?
- Inflammatory bank pain
- Iritisi/uveitis
- Enthesitis
- Fatigue
- Sleep disturbance
- Kyphosis
- Progressive loss of spinal movement
What is the back pain like in AS?
- insidious onset
- worse in morning
3, improve with exercise
What are possible DDx for AS?
- Osteoarthritis
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Psoratic arthritis
- Reactive arthritis
- Infection
- Bony metastases
What imaging is used for AS?
- MRI back
2. Pelvic X ray
Why do you do a MRI back?
detection of active inflammation and destructive changes
What would MRI back show in AS?
- Vertebral syndesmophytes are characteristic (T11-L1 initially)
- Bony proliferations due to enthesitisisbetween ligament and vertebrae, these fuse with the vertebral body above causing ankylosis
- bone marrow oedema (early)
What bloods are done and what do they show in AS?
- FBC: normocytic anaemia
- ESR: high
- CRP: high
- HLA-b27 positive
- Rh negative
What is 1st line treatment for AS?
NSAID e.g. naproxen 500mg 2x daily and exercise
What else would be added to the treatment of AS?
- Analgesia
- Intra-articular corticosteroid injection (if local intra-articular inflammation)
- Sulfasalazine or methotrexate (if peripheral joint involvement)
When may a TNF-alpha inhibitor and physiotherapy be used for AS?
if enthesitis and/or peripheral arthritis
What are possible complications for AS?
- Osteoporosis
- Cardiac involvement
- Hip involvement
- Iritis
- Pulmonary involvement
- Neurological involvement
When is the prognosis worse for AS?
- ESR>30
2, onset <16yrs - early hip involvement
- poor response to NSAIDs
What is seen the pathogonominic radiographic feature seen in AS?
bamboo spine
What does the inflammation start in AS?
- at sites of attachment of ligaments to the vertebral bodies (first in lumbar region)
- progresses to cervical and thoracic spine
- Potentially infective triggers?
What is enthestisis?
- plantar fasciitis
- Achilles’ tendonitis
- dactylitis
What is the extrarticular manifestations of AS?
- Anterior uveitis (40%)
- Apical lung fibrosis
- Aortic regurgitation
- Psoriasis, IBD Sx
What is needed for diagnosis of AS?
> 3 months inflammatory back pain, with sacroiliac joints + axial spine affected > peripheral joints
What is the defintion of AS?
Chronic, progressive inflammatory arthropathy of axial skeleton
+ Peripheral joints, entheses (tendon/ligament attachments) & extra-articular sites
