Ankylosing spondylitis
| Headline | |
|---|---|
| Etiology | Chronic inflammation of spine+sacroiliac joints |
| Epidemiology | typically male <age 40. 88% are HLA-B27 +ve |
| Clinical presentation | Low back pain radiating from sacroiliac joints to hips, morning stiffness; enthesitis/costochondritis ↓ lumbar lordosis+ ↑ thoracic kyphosis including thoracic expansion Extra-articular signs: iritis; anterior uveitis |
| Pathogenesis | |
| Diagnostic investigations | Clinical diagnosis Pelvic/spine XR: bamboo spine, fusion of SI joints, apparent fusion of spinous processes (calcification of interspinous+ supraspinous ligaments) |
| Management | Assess impact with BASDAI ➥ NSAIDs are first line (remember ~PPIs) ➥ With rheum referral: TNF α blockers ➥ If uncontrolled (etanercept, adalimumab), intra-articular steroid injections ➥ Surgical mx: hip replacement ➥ Prognosis worse if: onset<16 years, early hip involvement, ESR>30, poor response to ~NSAIDs |
| Prevention |