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Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disorder that primarily affects the axial skeleton. It often begins in late adolescence or early adulthood and causes dull back pain and morning stiffness. Diagnosis is based on criteria including inflammatory back pain, limited spinal mobility, and radiographic evidence of sacroiliitis. Treatment focuses on exercise, avoiding smoking, NSAIDs, and other medications or surgery depending on symptoms and severity.

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23 views14 pages

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disorder that primarily affects the axial skeleton. It often begins in late adolescence or early adulthood and causes dull back pain and morning stiffness. Diagnosis is based on criteria including inflammatory back pain, limited spinal mobility, and radiographic evidence of sacroiliitis. Treatment focuses on exercise, avoiding smoking, NSAIDs, and other medications or surgery depending on symptoms and severity.

Uploaded by

Tharen Official
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Ankylosing spondylitis

1
Introduction
• Inflammatory disorder of unknown cause
that primarily affects the axial skeleton;
peripheral joints and extraarticular
structures may also be involved.

• Second or third decade.

• The prevalence in the men is approximately


three times that in women.

• Prototype of the spondyloarthropathies. 2


Epidemiology

• HLA B27 (worldwide roughly in propotion


to the prevalence of this antigen),

• Strongly associated with inflammatory


bowel disease (IBD) : ulcerative colitis,
crohn’s disease.

3
Pathology
• Enthesitis (primary inflammation),

• Sacroiliitis,

• Ossification; syndesmophyte
(bamboo spine); bony ankylosing,

• Peripheral arthritis,

• Iritis (acute anterior uveitis). 4


Pathogenesis

• Uncompletely understood,

• Immune-mediated mechanisms and


close association with HLA B27,

• No specific event or exogenous agent


that triggers the onset of disease has
identified.

5
Clinical manifestations

• Late adolescence or early adulthood,

• The initial symptom : dull pain, insidious


in onset (lower lumba or gluteal region)
+ low-back morning stiffness,

• Bony tenderness,

6
• Common sites : costosternal junctions,
spinous processes, greater trochanters,
ischial tuberosities, tibial tubercles, and
heels.

• Peripheral joints (asymmetric)

• Extraarticular manifestations
- Acute anterior uveitis,
- IBD,
- Aortic insufficiency.

7
• Physical findings
- Loss of spine mobility,
- Pain in the sacroiiliac joints (direct pressure).

• The course of the disease is extremely


variable,

• Worse prognosis
- Adolescence,
- Early severe hip.

8
• Complications
- Spinal fracture (spinal cord injury),

- Osteoporotic spine,

- Cauda equina sndrome and slowly progressive


upper pulmonary lobe fibrosis rare,

- Aortic insufficiency; cardiac conduction


disturbances,

9
Laboratory findings

• No laboratory test is diagnostic of AS,

• Ethnic groups, the HLA B27 (90%),

• Elevated erythrocyte sedimentation rate


and CRP,

• Mild normochromic, normocytic anemia.


10
Radiographic findings

• Sacroiliitis,

• Syndesmophytes,

• CT, MRI.

11
Diagnosis
• Modified New York criteria (1984)
1. A history of inflammatory back pain,
2. Limitation of motion of the lumbar spine in
both the sagital and frontal planes,
3. Limited chest expansion, relative to standard
values for age and sex,
4. Definite radiographic sacroiliitis.

Using these criteria, the presence of radiographic


sacroiliitis plus any one of the other three criteria is
sufficiency for a diagnosis of definite AS.
12
• The presence of B27 is neither necessary
nor sufficient for the diagnosis, but the B27
test can be helpful in patient with
suggestive clinical findings who have not
yet developed radiographic sacroiliitis.

• Must be differentiated from numerous


other causes of low-back pain.

13
Treatment

• Exercise,
• ↕Smoking,
• NSAIDs,
• Sulfasalazine; methotrexate,
• Surgery,
• Iritis (glucocorticoids).

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