Ankylosing Spondylitis Flashcards Preview

Orthopaedics > Ankylosing Spondylitis > Flashcards

Flashcards in Ankylosing Spondylitis Deck (12)
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1
Q

What is ankylosing spondylitis

A

A chronic seronegative spondyloarthropathy which primarily involves the axial skeleton

2
Q

Who is most likely to initially present with ankylosing spondylitis

A

Men between 20-30

3
Q

What is the genetic association with ankylosing spondylitis

A

Strong association with HLA B27

4
Q

How do patients with ankylosing spondylitis present

A

Insidious onset

Morning stiffness

Inflammatory back pain:

  • Improves with moderate physical activity
  • Starts in sacroiliac joints so may be felt as diffuse buttock pain

Peripheral enthesitis - 1/3 of patients

Peripheral arthritis - 1/3 of patients

5
Q

What do you see on examination of a patient with ankylosing spondylitis

A

Question mark posture - neck hyperextension and thoracic kyphosis

Progressive loss of all spinal movements - Schober’s test less than 5cm

Tragus to wall distance increased

Extra-articular manifestations

6
Q

What is peripheral enthesitis

A

Occurs in 1/3 of patients with ankylosing spondylitis

Commonly Achilles tendonitis and plantar fasciitis

Lesions tend to be painful, especially in the morning

May be associated swelling of tendon or ligament insertion

7
Q

What peripheral arthritis occurs in ankylosing spondylitis

A

Occurs in 1/3 of patients

Usually asymmetrical

Involving:

  • Hips
  • Shoulder girdle
  • Joints of the chest wall (costochondritis)
  • Symphisis pubis

Other peripheral joints less often and less severely affected

8
Q

What are the extra-articular manifestations of ankylosing spondylitis

A

AAAAAAO - 6 As

Eyes - Acute anterior uveitis

Cardiovascular - Aortic regurgitation

Respiratory - Apical fibrosis

Renal - Amyloidosis (v. rare), IgA nephropathy

Neurological - Atlanto-axial subluxation

Metabolic bone disease - Osteoporosis

9
Q

What medication might a patient with ankylosing spondylitis be on

A

NSAIDs

TNF-alpha inhibitors - if symptoms poorly controlled with NSAIDs (eg. etanercept)

Bisphosphonates - treat osteoporosis

10
Q

What surgery might a patient with ankylosing spondylitis have

A

To correct spinal deformities

To repair damaged peripheral joints

11
Q

How do you diagnose ankylosing spondylitis

A

Modified New York Criteria

  • Low back pain - for over 3 months, improved by exercise, not relieved by rest
  • Limitation of lumbar spine motion
  • Limitation of chest expansion relative to normal values for age and sex
12
Q

What is the differential diagnosis for a patient with ankylosing spondylitis

A

Mechanical back pain

OA

Inflammatory eg. RA