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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