Ankylosing spondyitis

Ankylosing spondylitis

Chronic inflammatory sero-ve arthritis characterised by progressive stiffening and fusion of axial skeleton

Predominantly affecting the sacroiliac joints and spine

Clinical feature

 

                 Age-Young

                 Sex-Male >Female(3:1)

                 Low back pain  and inflammatory features ,radiation to buttock and thigh

Extra articular-

• Eye-Iritis ,conjunctivitis  ,photophobia 
• Cardiovascular-Aortic regurgitation ,mitral regurgitation ,pericarditis
• Respiratoty-Chest pain(Costochondral fusion) ,reduced expansion ,upper lobe fibrosis ,cavitation ,pulmonary hypertension ,Cor pulmonale
•  Prostatitis
• Nervous-Cauda equina syndrome

New York criteria

             Low back pain for at least  3months ,improves by exercise and not relieved by rest

             Limitation of lumbar spine movement in at least 2 planes

             Reduced chest expansion

             Bilateral sacroilitis grade 2-4

             Unilateral sacroilitis grade 3-4

Sacroilitis with any criteria is  definite Ankylosing spondylits

Hallmark

• Inflammation  at ligamentous attachment with erosion of bone. Healing of such lesion at  IV disc and vertebral bodies causes new bone formation called syndesmophyte

Aortic regurgitation of Rheumatic fever vs Aortic regurgitation of ankylosing spondylitis

             In Rheumatic fever ,echo shows involvement of valve cusp(Short ,thick ,and fused)

             In Ankylosing spondylitis ,echo shows involvement of aorta due to aortitis

Trait	Syndesmophyte	Osteophyte
Growth	Grows longitudinally above or below and caused bridging	Horizontally ,and does not cause bridging
Hallmark	Hallmark of Ankylosing spondylitis	Hallmark of Ostearthritis

Death inAnkylosing spondylitis

                     Amyloidosis

                     Spine fracture

Investigation

                 X ray spine and SI

o   SI-Irregular ,loss of cortical margin  wide joint space

o   Thoracolumbar spine-Squaring due to erosion ,syndesmophyte leading to bambospine

                 MRI of lumbosacral spine

                 Rheumatoid factor

                 HLA B27

                 Barium enema for excluding IBD 

Treatment

                     Exercise(Swimming)

                     Avoid prolonged sitting

                     NSAIDs

                     DMARDs

                     Physiotherapy

                     Local steroid inj.

Radiological differential diagnosis

                    Alkaptonuria(Calcification of IV disc)

                    DISH(Flowing wax on anterior body vertebra ,with normal SI)

                    Lumbar spondylosis(Narrowing of  space)