Ankylosing Spondylitis

Question 1

What is Ankylosing Spondylitis?

Answer 1

• Inflammatory condition that affects the spine causing progressive stiffness and pain

Question 2

What are the common clinical features of spondyloarthropathies?

Answer 2

• seronegativity
• HLA B27 association (90% positive)
• Axial arthritis (spine and sacroiliac joints)
• Asymmetrical large joint oligoarthtitis
• Enthesitis
• Dactylitis
• Extra-articular manifestations
  
  • iritis, psoriaform rashes, oral ulcers, aortic valve incompetence, IBD

Question 3

What are the joints affectd in AS?

Answer 3

• sacroiliac joint
• vertebral column joints

Question 4

What is the typical presentation of AS?

Answer 4

• Male in late 20s
• Sx gradually develop >3months
• lower back pain
• worse at night, morning stiffness - relieved c exercise
• pain radiates to buttock - improves towards end of day

Question 5

What are the associatig Sx for AS?

Answer 5

• Systemic: weight loss, fatigue
• chest pain
• enthesitis
• dactylitis
• anaemia
• ant. uveitis
• aortitis
• HB
• IBD

Question 6

What Ix would you perform for AS?

Answer 6

*Clinically diagnosis

• Bedside
  
  • Schober’s test <20cm
  • Genetic testing: HLA B27
  • Inflammatory markers
• Imaging
  
  • Xray
  • MRI

Question 7

Why is MRI used for AS?

Answer 7

can detect:

• active inflammation - bone marrow oedema
• erosions
• sclerosis
• ankylosis

Question 9

What features will you find on xray for AS?

Answer 9

• sacroiliitis: subchondral erosions, sclerosis
• squaring of lumbar vertebrae
• ‘bamboo spine’ (late & uncommon)
• syndesmophytes: due to ossification of outer fibers of annulus fibrosus
• chest x-ray: apical fibrosis

Question 10

How would you Mx AS?

Answer 10

• Conservative
  
  • Exercise - x rest
  • Physio - maintain posture and mobility
• Pharmacology
  
  • NSAIDs
  • Steroids
  • anti TNF (etanercept, adalimumab)
  • Secukinumab - if NSAIDs and anti TNF x work

Question 11

What is secukinumab?

Answer 11

• monoclonal antibody against IL 17

Question 12

What other features are associated with AS?

*think the As

Answer 12

• Apical fibrosis
• Anterior uveitis
• Aortic regurgitation
• Achilles tendonitis
• AV node block
• Amyloidosis
• and cauda equina syndrome
• peripheral arthritis (25%, more common if female)