Ankylosing Spondylitis

Aka ‘bamboo spine’, ‘poker back’, Marie-Strumpell Disease

  • Seronegative spondyloarthropathy
  • Closely associated with others e.g. reactive arthritis, Reiter’s syndrome, psoriatic arthritis
  • 90% of AS sufferers have HLA-B27 antigen (present in 8% of population)
  • affects 0.2% of population
  • males 4:1 femaies
  • typical onset 15-35 years of age
  • more common in Caucasians

Typical presentation

  • insidious onset
  • Lumbo-sacral pain (often bilateral) which can refer to posterior thigh
  • Early morning stiffness
  • decreased range of movement in lumbar spine
  • often presents with acute uveitis
  • worse for periods of rest e.g. in bed
  • better for mild to moderate exercise and hot showers

Progression

  • Inflammatory erosion of tendon and ligament attachment to bone
  • Begins with bilateral involvement of sacro-iliac joints
  • Progresses up spine forming bony bridges between vertebrae
  • Can progress up through TSp to CSp
    • Affects movement of ribs à heart, lungs
    • Causes abnormal weight bearing à hips
    • Prognosis with treatment is good
      • Exercise
      • Weight control
      • NSAIDs for pain relief

Clinical Tests

  • increased ESR and CRP
  • HLA testing
  • X-ray

References

  • Porth, C (2005). Pathophysiology: Concepts of Altered Health States. 7th ed. Philadelphia: Lippincott Williams & Wilkins. p1425-7.
  • Vizniak, N & Carnes, M (2009) Conditions Manual, 3rd ed. Canada: Professional Health Systems. 342-3
  • Clark, M & Kumar, P (2009). Kumar and Clark’s Clinical Medicine. 7th ed. London: Saunders Elsevier. p532-4.

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