ANKYLOSING SPONDYLITIS Flashcards Preview

ORTHOPEDICS AND RHEUMATOLOGY > ANKYLOSING SPONDYLITIS > Flashcards

Flashcards in ANKYLOSING SPONDYLITIS Deck (21):
1

Define ankylosing spondylitis.

Chronic systemic inflammatory disease of the spine and sacro-iliac joints, which eventually leads to fusion of the spinal vertebra.

2

Are males or females more affected by ankylosing spondylitis and what is the ratio?

Females
2:1

3

Are northern Europeans or Afro-Caribbeans more susceptible to ankylosing spondylitis?

Northern Europeans

4

What is the only known risk factor for ankylosing spondylitis?

HLA-B27 positive

5

What percentage of people with ankylosing spondylitis are HLA-B27 positive?

90%

6

What are the main two cytokines involved in ankylosing spondylitis?

TNFα
IL-1

7

How might someone with suspected ankylosing spondylitis present? (Name 5 symptoms)

Lumbar back pain
Worst at night
Morning stiffness
Relieved during exercise
Pain radiating from sacro-iliac joints to hips and buttocks
Stooping
Pain in tendons such as Achilles tendon
Eye pain
Problems breathing (comes much later)

8

On examination, what signs might a patient with suspected ankylosing spondylitis display?

Signs of enthesitis
Uveitis
s test
Loss of spinal movement
Occiput-to-wall test shows kyphosis
Neck hyperextension

9

What tests would you do to confirm a diagnosis of ankylosing spondylitis?

X-ray
MRI
Blood tests

10

What might a blood test show in someone with ankylosing spondylitis?

Normocytic anaemia
Raised ESR
Raised CRP
HLA-B27 positive

11

What might you see on a X-ray of someone with ankylosing spondylitis?

Sacroiliitis
Erosions
Sclerosis
Syndesmophytes
Bony proliferations due to enthesitis
Ankylosis
Bamboo spine (later stage)

12

What causes bamboo spine?

Ossification of outer fibers of fibrous ring of inter-vertebral disk, leading to development of syndesmophytes.

13

What is enthesitis?

Inflammation at the site of insertion of ligaments and tendons into bone. Common tendon affected is the Achilles.

14

What group of diseases does ankylosing spondylitis fall under?

Seronegative Spondyloarthropathies

15

What makes seronegative spondyloarthropathies seronegative?

A lack of rheumatoid factor

16

Why is there a lag time between the onset of ankylosing spondylitis and diagnosis?

Because the signs and symptoms are so unspecific.

17

What is the average lag time between onset of ankylosing spondylitis and diagnosis?

8.5 to 11.4 years

18

What are the serious complications of ankylosing spondylitis?

Osteoporosis - fracture as a result of minor trauma

19

What might an MRI scan show you in a patient with ankylosing spondylitis?

Sacroiliitis
Erosions
Sclerosis
Syndesmophytes
Bony proliferations due to enthesitis
Ankylosis
Bamboo spine (later stage)
Shiny corner sign

20

What does shiny corner sign indicate?

Small erosions at superior and inferior endplates with surrounding reactive sclerosis.

21

What are the management options for someone diagnosed with ankylosing spondylitis?

Exercise (including intense exercise regimes)
Physiotherapy - Posture
NSAIDs
TNFα blockers (Etenercept)
Adalimumab
Golimumab
Local steroid injections
DMARDs (more useful if there is an element of peripheral arthritis)
Surgery - hip replacement
Bisphosphonates