ankylosing spondylitis

Question 1

what is ankylosing spondylitis

Answer 1

HLA-B27 associated spondyloarthropathy
presents in males aged 20-30

Question 2

features of ankylosing spondylitis

Answer 2

young man who presents with lower back pain and stiffness of insidious onset
stiffness worse in the morning and improves with exercise
pain at night which improves on getting up

Question 3

clinical examination of ankylosing spondylitis

Answer 3

reduced lateral flexion
reduced forward flexion- schober’s test
reduced chest expansion

Question 4

other features associated with ankylosing spondylitis

Answer 4

the As
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina
peripheral arthritis

Question 5

investigations for ankylosing spondylitis

Answer 5

inflammatory markers (ESR, CRP)
HLA-B27
plain x-ray most useful
if x-ray neg but still suspect AS -> MRI

Question 6

findings on plain xray suggestive of ankylosing spondylitis

Answer 6

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
bamboo spine (late and uncommon)
syndesmophytes: due to ossifications
chest x-ray apical fibrosis

Question 7

management of ankylosing spondylitis

Answer 7

encourage regular exercise such as swimming
NSAIDs first line
physiotherapy
DMARDs (sulphasalazine)- only really useful if peripheral joint involvement