Ankylosing Spondylitis
Title
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Ankylosing Spondylitis
Definition
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Systemic rheumatic disorder
Characterised by:
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Inflammation of the:
Axial skeleton
Large peripheral
joints
Pathogenesis
Causes
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Related to the incidence of HLA-B
27
Pathological Process
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Inflammation with infiltration
by lymphocytes and plasma cells
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Erosion of bone at attachment of
ligaments
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Heals with new bone formation:
Syndesmophytes
Clinical Features
History
Sex
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Males > Females
Age
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20- 40 years
E&M
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Low-grade fever
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Weight loss
GIT
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Anorexia
LMS
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Pain and stiffness in the back
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Worse in the morning
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Relieved by activity
Examination
E&M
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Weight loss
CVS
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Aortic regurgitation
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Angina
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Conduction defects
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Pericarditis
RS
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Apical fibrosis and cavitation
CNS
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Anterior uveitis
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Radiculitis
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Sciatica
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Cauda equina syndrome
LMS
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Loss of lumbar lordosis
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Kyphosis
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Decreased spinal movements
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Vertebral fracture, subluxation
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Costochondritis
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Peripheral joint involvement:
Asymmetrical
Large joints affected
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Entheses affected
KUS
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Amyloidosis
Investigations
Fluids
Blood
Haematology
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ESR:
Mildly elevated
Biochemistry
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CRP:
Mildly elevated
Immunology
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HLA-B27:
·
Positive:
Supporting evidence
Imaging
Spine X-Ray
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Sacroiliitis
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Squaring of vertebrae
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Demineralisation of bone
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Ligamentous calcification
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Bamboo spine ultimately
MRI
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Irregularities, erosions,
sclerosis of lower half of the sacroiliac joints, especially the iliac side
Management
Control
Drugs
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NSAIDs:
For pain
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Sulphasalazine and methotrexate:
May help peripheral arthritis
Biological Agents
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TNF alpha blockers:
Infliximab, etanercept, adalimumab
Staffing
Physiotherapy
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Spinal and
chest exercise
Prognosis
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Mortality
higher than expected:
Amyloidosis
Heart disease
