Ankylosing spondylitis

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Background

  • Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton with variable involvement of other joints or even nonarticular structures.
  • Ankylosing spondylitis is three times more common in males than females. It is usually diagnosed in young adults between the ages of 20 and 30 years.
  • Often associated with other autoimmune disorders. About 90% of people with AS express the HLA-B27 genotype.

Clinical Features

  • Spinal pain, particularly in the lower back, is usually the first and most common symptom of AS.
    • Begins in early adulthood (before 45 years of age)
    • Has a gradual onset
    • Lasts longer than three months
    • Is worse after rest (for example, in the morning) but improves with activity
    • Can cause morning stiffness lasting more than 30 minutes
  • Fatigue
  • Can also be associated with anterior uvetitis, bowel ulcers and spinal fractures are 4 times more common in patients with AS

Differential Diagnosis

Lower Back Pain

Diagnosis

  • There is no direct test for AS
  • ESR, CRP can be elevated but not sensitive or specific for AS
  • Xray lumbar/sacroiliac: The earliest changes in the sacroiliac joints shows erosions and sclerosis.
    • Progression of the erosions leads to pseudo widening of the joint space and bony ankylosis AKA "Bamboo Spine."

Management

Disposition

See Also

External Links

References