What is ankylosing spondylitis?
A seronegative inflammatory spondyloarthropathy
Spondyloarthropathy = family of inflammatory rheumatic diseases.
What is the typical patient with AS?
A young, Caucasian in their mid-teens or twenties on first presentation
What is the pain pattern in AS?
- Insidious onset back pain at night and early in the mornings particularly on inactivity
- Unilateral buttock pain that radiates into the groin
What improves AS?
Exercise
What findings may be seen on spinal X-ray in patient with AS?
- Sacroiliitis (subchondral sclerosis and erosions)
- Squaring of the lumbar vertebrae
- Syndesmophytes
- Bambboo spine (very late sign)
Syndesmophytes = bony growths that can cause fusion of the joints
What finding may be seen on chest X-ray of someone with AS?
Pulmonary apical fibrosis
Rare extra-articular manifestation
What may an MRI scan of AS show?
Oedema and sacroiliitis
MRI scan may show oedema at early stage
What protein in the blood is AS associated with?
HLA-B27
Which other conditions are also associated with HLA-B27 and therefore AS?
- Inflammatory bowel disease
- Psoriatic arthritis
- Anterior uveitis
Check for all of these in family history of AS patient
What are the management steps for AS?
- Regular exercise
- NSAIDs
- Physiotherapy
- DMARDs if there is peripheral joint involvement
- Specialist consideration for anti-TNF drugs
What are the general tips for managing lower back pain?
- Encourage self-management
- Continue physical activity
- NSAIDs as first line and co-prescribe PPI if over 45 years old to protect stomach lining against NSAIDs
- Physiotherapy
Name the 10 key differentials of lower back pain
- Muscular strain or sprain
- Herniated nucelus pulposus
- Sacroiliitis
- Compression fracture
- Spinal stenosis
- Degenerative disc disease or facet arthropathy
- Cauda equina or spinal cord compression
- Spondylosis or spondyloisthesis
- Vertebral discitis or osteomyelitis
- Malignancy
Which condition is most likely if the spinal pain is relieved on leaning forward?
Spinal stenosis
