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Ankylosing spondylitis

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Immunology

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Ankylosing spondylitis

  1. 1. Ankylosing Spondylitis Dept of Medicine, ACMS
  2. 2. Pathology • Sacroiliitis • Spine • Enthesitis
  3. 3. Clinical manifestations • Dull low back pain • Bony tenderness • Arthritis • Neck pain and stiffness • Juvenile variant
  4. 4. On examination • Decreased spinal mobility – Modified schober’s test – Chest expansion • Pain in sacroiliac joint • Pain in hips and shoulder
  5. 5. Progression of the disease
  6. 6. Posture changes • Loss of lumbar lardosis • Buttock atrophy • Accentuated thoracic kyphosis • Forward flexion of the neck • Flexion of hip with compensatory flexion of kness
  7. 7. MEASURE OF DISEASE PROGRESSION AS
  8. 8. Parameters •Loss of height •Limitation of chest expansion •Spinal flexion •Occiput-wall distance •Floor gaze angle
  9. 9. Poor prognostic markers & complications • Early onset disease • Early hip involvement • Smoking • Spinal fractures – Lower cervical spine – Neural damage
  10. 10. Extraarticular manifestations Common • Anterior uveitis • IBD • Psoriasis • AR • Complete heart block Rare • Cauda equina syndrome • Upper lobe fibrosis • Retroperitoneal fibrosis • Amylodosis
  11. 11. Measurement of disease activity • BASDAI • BASFI • Cause of death – Spinal trauma – AR – Respiratory failure
  12. 12. Lab • HLA-B27 • ESR/CRP • Anemia • ALP • Spiromerty
  13. 13. Radiology Sacroiliac joint In AS
  14. 14. Radiology Cervical spine Lumbar spine
  15. 15. ASAS criteria for classification of axial SpA SI on imaging plus ≥1 SpA feature HLA-B27 plus ≥2 other SpA features Sacroilitis on imaging SpA features Active inflammation on MRI highly suggestive of SpA associated SI Inflammatory back pain Arthritis Enthesitis And/or Anterior uveitis Definite radiographic sacroiliitis according to modified New York criteria Dactylitis Psoriasis Crohn’s disease or UC Good response to NSAIDs Family history of SpA HLA-B27 Elevated CRP

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