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1

This is a chonic, inflammatory arthritis primarily affecting the articulations & ligs of the spine & pelvis

Ankylosing Spondylitis

2

Ankylosing Spondylitis is AKA?

Marie-Strumpell, Bechterev, rhizomelic spondylitis

3

Ankylosing Spondylitis is a common cause of low back pain in what group of people?

Young males (15-35 yrs of age; 9:1 M-to-F)

4

Where is aching/stiffness M/C w/ Ankylosing Spondylitis?

In sacral region

5

What is the typical clinical presentation of Ankylosing Spondylitis?

Pain at max in morning
Pain/tenderness over bony prominences
Chest pain (costochondral involvement)
Fatigue,low grade fever
Iritis, heart problems, upper lung fibrosis

6

What % of pt's w/ Ankylosing Spondylitis have peripheral involvement?

up to 50%

7

What are typical lab findings w/ Ankylosing Spondylitis?

Positive HLA-B27 (90-95% of cases)
ESR
Negative for RF

8

What are the characteristic sites of involvement for Ankylosing Spondylitis?

SI joints (M/C; hallmark)
Apophyseal joints
Costovertebral joints
Pubic symphysis
Discovertebral
Manubriosternal joints

9

What are basic features of Ankylosing Spondylitis radiographically in the SI joints?

Reactive Sclerosis
Osteoporosis
Bony ankylosis
Erosions
Typically bilateral & symmetrical

10

What are the most diagnostic views for Ankylosing Spondylitis in the SI joints?

PA angulated spots or SI views

11

What are the stage 1 changes in SI joints w/ Ankylosing Spondylitis?

Pseudo-widening of joint

12

What are the stage 2 changes in SI joints w/ Ankylosing Spondylitis?

Erosive & sclerotic changes

13

What are the stage 3 changes in SI joints w/ Ankylosing Spondylitis?

Ankylosis 50% (7-23 years)

14

What radiographic signs are assoc. w/ ankylosing spondylitis in the SI?

Ghost joint margins
Star sign

15

Erosive changes w/ ankylosing spondylitis in the SI are seen more on what part of the joint?

Iliac side of the joint & lower 1/3rd of the joint

16

Where are the earliest spinal manifestations radiographically of ankylosing spondylitis?

Thoracolumbar region (M/C)

17

This is an erosion at the corner of a vert. body assoc. w/ ankylosing spondylitis

Romanus lesion

18

Vert. bodies become what shape w/ ankylosing spondylitis?

Squared contour, barrel shaped

19

This radiographic sign is d/t osteitis in the spine of a pt w/ ankylosing spondylitis

Shiny corner sign

20

Ossification of the outer edges of the disc in a pt w/ ankylosing spondylitis is called what?

Marginal syndesmophytes

21

Names assoc. w/ ankylosing spondylitis in the spine?

Bamboo spine, Trolley-track, dagger sign

22

Type of fx assoc. w/ ankylosing spondylitis in the spine?

Carrot-stick fx

23

Lesion that is assoc. w/ ankylosing spondylitis that looks like an infection & is M/C in the C-spine

Anderson lesion

24

This arthropathy is assoc. w/ ulcerative colits & crohn's disease

Enteropathic arthropathy

25

Enteropathic Arthropathy affects what group of people?

Young adults

26

What is a typical clinical symptom of enteropathic arthropathy?

Peripheral arthralgias w/ rapid resolution (knee, ankle, elbow, wrist)

27

What % of time is there spinal involvement w/ enteropathic arthropathy?

5%

28

What lab test is positive w/ enteropathic arthropathy?

HLA-B27

29

How does enteropathic arthropathy appear radiographically?

Similar to ankylosing spondylitis (bilateral & symmetrical)

30

Common skin disorder assoc. w/ joint disease characterized by peripheral joint destruction & deformity, sacroiliitis, & non-marginal syndesmophytes

Psoriatic Arthritis