Inflammatory Spondyloarthropathy

Question 1

Ankylosing spondylitis is a chronic inflammatory disease of the spine and sacroiliac joints. It typically presents in males (3:1) aged 20-30 years old. Around 90% are HLA B27 positive.

What are clinical features of ankylosing spondylitis?

Answer 1

• Gradual onset lower back pain
  
  • worse during night
  • spinal morning stiffness relieved by exercise
  • pain radiates from sacroiliac joints to hips/buttocks + usually improves towards end of day
• Progressive loss of spinal movement (all directions)
  
  • lateral flexion
  • forward flexion → Schober’s test: line drawn 10cm above + 5cm below back dimples, distance between two lines should increase by >5cm when pt bends as far forward as possible
• Reduced chest expansion
• Other features – the ‘As’
  
  • Apical fibrosis / Anterior uveitis / Aortic regurg / Achilles tendonitis / AV node block / Amyloidosis / And cauda equina syndrome

Question 2

What investigations are done for ankylosing spondylitis?

Answer 2

• FBC
• ESR, CRP
• HLA B27
• X-ray
• CXR → may show apical fibrosis

Question 3

Sacroiliac joints may be normal in early disease.

What are the late radiological changes on X-ray in ankylosing spondylitis?

Answer 3

• Sacroilitis → subchondral erosions, sclerosis
• Squaring of lumbar vertebrae
• ‘Bamboo spine’ (late + uncommon)
• Syndesmophytes - due to ossification of out fibres of annulus fibrosus

Question 4

What is the conservative management of ankylosing spondylitis?

Answer 4

• regular exercise
• intense exercise regimens to maintain posture + mobility, ideally w/ specialist physio

Question 5

What is the medical treatment of ankylosing spondylitis?

Answer 5

• NSAIDs are 1^st line → relieves symptoms within 48hrs
• anti-TNF therapy (etmercept, adalimumab) → given to pts w/ persistently high disease activity despite conventional treatments

Question 6

What is the surgical treatment for ank spond?

Answer 6

• Hip replacement
• improves pain + mobility if hips are involved