Ankylosing spondylitis

Question 1

What is ank spond?

Answer 1

A chronic progressive inflammatory seronegative spondyloarthropathy. It predominantly affects the sacroiliac joints and the axial spine.

Question 2

What are risk factors for ank spond?

Answer 2

• Family history
  
  • HLA-B27
  • Presentation in late adolescence and early 20s
  • Male

Question 3

What are clinical features of ank spond?

Answer 3

○ Early morning back stiffness
		○ Improvement of stiffness with exercise 
		○ Insidious onset
		○ Age <40 years at onset 
		○ Back pain lasting > 3 months
	• Tenderness at sacroiliac joint 
	• Iritis and uveitis 
	• Enthesitis 
Fatigue

Question 4

What are features of ank spond in advanced disease?

Answer 4

• Progressive loss of spinal movement
• Reduced chest expansion
Chest pain and dyspnoea due to costochondritis

Question 5

What investigations in ank spond?

Answer 5

Pelvic x-ray and spinal MRI. MRI better at seeing inflammation.

Bloods: HLAB27, ESR, CRP

Question 6

What differential diagnoses?

Answer 6

• Ankylosing Spondylitis
  
  • Other Axial Spondylarthropathy
  • Mechanical back pain
  • Trauma
  • Malignancy
  • Infection
  • Degenerative back pain

Question 7

What is diagnostic criteria for axial SpA?

Answer 7

Sacroilitis on imaging + 1 or more SpA feaure

HLAB27 +ve with 2 or more SpA featuers

Question 8

What is treatment of ank spond?

Answer 8

NSAIDs, physiotherapy, paracetamol,

DMARDs if not working

Question 9

What are complications of ank spond?

Answer 9

• OP
	• Cardiac involvement
	• Hip involvement
	• Iritis
	• Pulmonary involvement 
Neurological involvement