ankylosing spondylitis

Question 1

what are Spondyloarthropathies

Answer 1

Chronic inflammatory diseases that most commonly affect SI joints + axial skeleton

Question 2

which gene are Spondyloarthropathies associated with

Answer 2

HLA B27 gene

Question 3

what is the serostatus of spondyloarthropathies

Answer 3

Seronegative (RF –ve)

Question 4

examples of spondyloarthropaties

Answer 4

• ankylosing spondylitis
• Psoriatic arthritis
• Reactive arthritis
• IBD associated arthritis
• Juvenile idiopathic arthritis

Question 5

general features of spondyloarthropathies

Answer 5

SPINEACHE
Sausage digit (dactylitis)
Psoriasis
Inflammatory back pain
NSAID → good response
Enthesitis (heel)
Arthritis
Crohn’s/ colitis/ elevated CRP (can be normal)
HLA B27
Eye (uveitis)

Question 6

define ankylosing spondylitis

Answer 6

Chronic, multisystem inflammatory disorder involving primarily the sacroiliac joints + axial skeleton

Question 7

who does ankylosing spondylitis present in

Answer 7

males 20-30
It affects 3 times more men than women.

Question 8

pathophysiology of ankylosing spondylitis

Answer 8

1. Initially, the subchondral bone is infiltrated by granulation tissue, causing lesions that lead to joint erosion, ossification, and then fusion of the bone.
2. If the synovium is affected, macrophages and lymphocytes infiltrate and the cartilage/fibrous tissue is replaced by a scar-like fibroblast invasion, which ossifies, fusing the bones.

Question 9

signs and symptoms of ankylosing spondylitis

Answer 9

Pain and stiffness are worse with rest/in the morning and improve with movement.
- Lower back and gluteal pain
- Enthesitis (inflamed tendon insertions)
- Peripheral arthritis
- Stiffness of affected joints
- Chest pain
- Dactylitis (inflammation of whole finger)
- Vertebral fractures
- Shortness of breath (restricted chest wall)

Question 10

conditios associated with ankylosing spondylitis (5 A’s)

Answer 10

Anterior Uveitis
Aortic Regurgitation
Atrioventricular Block
Apical Lung Fibrosis
Anaemia of Chronic Disease

Question 11

investigations for ankylosing spondylitis

Answer 11

1. Schober’s Test
2. inflammatoey markers
3. genetic testing
4. x ray
5. MRI

Question 12

what is schobers test

Answer 12

A test to measure spinal mobility

Question 13

how to do schobers test

Answer 13

1. The L5 vertebrae is located, and a mark is placed 10cm above and 5cm below.
2. The patient is asked to bend fully forward and a length of less than 20cm between points indicates restriction in lumbar movement
3. therefore shows decreased lumbar flexion

Question 14

what to perform x ray of for ankylosing spondylitis

Answer 14

spine and sacrum

Question 15

why do you do mri for ankylosing spondylitis

Answer 15

to look for bone marrow oedema

Question 16

x ray changes seen with ankylosing spondylitis

Answer 16

1. Subchondral sclerosis and erosions
2. Syndesmophytes
3. Ossification of ligaments, discs, and joints
4. Fusion of the facet, sacroiliac, and costovertebral joints
5. Bamboo spine

Question 17

first line treatment for ankylosing spondylitis

Answer 17

NSAIDS

Question 18

second line treatment for ankylosing spondylitis

Answer 18

Anti-TNF medications

Question 19

third line treatment for ankylosing spondylitis

Answer 19

• JAK inhibitor (Upadacitinib)
• Monoclonal antibodies for interleukin-17 (Secukinumab or ixekizumab) –

Question 20

other treatment options for ankylosing spondylitis

Answer 20

• intra-articular steroid injections (IF SEVERE)
• Additional management includes physiotherapy, no smoking, bisphosphonates, and surgery.