Ankylosing Spondylitis..ANKYLOSING SPONDYLITIS Also known as Axial Spondylitis. INTRODUCTION Ankylosing Spondylitis : Greek word Ankylos- Bent- Stiffness – Fusion Spondylitis- Inflammation of the spinal Vertebrae. Spondylos- Vertebrae Itis - Inflammation Defination Ankylosing Spondylitis is a type of Arthritis that causes inflammation in the joint and ligament of the spine. It also may affect Peripheral joints such as knees, ankle, hips. Over time the inflammation in the joints and tissue of the spine can causes back pain, stiffness leading into Rigid and inflexible spine. In severe cases, the bones in the spine fuses together completely resulting in a long Bony coloumn also known as Bamboo Spine. PREVALENCE… Peak age of onset is 15to 35 yrs. Prevalence varies between 0.1% and 2% in different population. The male : female ratio is around 5:1 Causes of ankylosing spondylitis It has no known specific causes, but both genetics and environment factors seems to be involved . Genetics-Human Leukocytes Antigen HLA-B27 Environmental Factors- Infections, Toxins, Pollutants, Injury to affected joints, Changes in bacteria in your colon and Bowel inflammations. Signs and symptoms… They usually began in late Adolescence or early adulthood and may include:- Neck pain and stiffness. Arthritis in the hip and shoulder. Low Back pain and stiffness in the morning which wears off during the day or with activity. Others symptoms… Chest pain or Tightness. Swollen fingers or toes. Tenderness in heels. Eyes Inflammation (Uveitis) Pain and swelling in joints other then those in the spine. diagonosis History And Physical Examinations Imaging Test [X-ray & MRI ] Blood Tests And Laboratory tests. History of Pain and stiffness Morning stiffness that last for more than 30 min of duration. Whether symptoms relieve on activity or worsen with inactivity. Awakening because of the back pain during the second part of night. If the patient experience alternative buttocks pain. Family History. Physical examinations… A Physical Examination may include the following :- Joint Examinations- Assessing the Range of Motion along the joints and the stiffness. Checking the Flexibility [Schober’s Test] Chest Expansion Test. Lumbar Mobility tests… Finger to Floor Distance Test Lumbar Lateral Flexion Distance Test Schober’s test The examiner make mark at the level of L5. The examiner then places one finger 5cm below this mark, and another, second ,finger 10cm above mark. The patient is asked to touch his toes. By doing so, the dstance between the two fingers of the examiner increases. However the restriction in the Lumber Flexion of the patient reduces this distances. If the distance increases less than 5cm then there is an indication is that the flexion of lower back is limited. Checking flexibility It involves watching how he move and bend in different directions. A tape is used to measure flexion and extension of the lumbar spine.

1. Also known as Axial
Spondylitis.

2.  Ankylosing Spondylitis : Greek word
Ankylos- Bent- Stiffness – Fusion
Spondylitis- Inflammation of the spinal
Vertebrae.
Spondylos- Vertebrae
Itis - Inflammation

3.  Ankylosing Spondylitis is a type of Arthritis
that causes inflammation in the joint and
ligament of the spine.
 It also may affect Peripheral joints such as
knees, ankle, hips.

4.  Over time the inflammation in the joints and tissue of
the spine can causes back pain, stiffness leading into
Rigid and inflexible spine.
 In severe cases, the bones in
the spine fuses together completely
resulting in a long Bony coloumn
also known as Bamboo Spine.

6. Peak age of onset is 15to 35 yrs.
Prevalence varies between 0.1% and 2%
in different population.
The male : female ratio is around 5:1

7.  It has no known specific causes, but both genetics
and environment factors seems to be involved .
 Genetics-Human Leukocytes Antigen HLA-B27
 Environmental Factors- Infections, Toxins,
Pollutants, Injury to affected joints, Changes in
bacteria in your colon and Bowel inflammations.

8.  They usually began in late Adolescence or early
adulthood and may include:-
 Neck pain and stiffness.
 Arthritis in the hip and shoulder.
 Low Back pain and stiffness in the morning which
wears off during the day or with activity.

9.  Chest pain or Tightness.
 Swollen fingers or toes.
 Tenderness in heels.
 Eyes Inflammation (Uveitis)
 Pain and swelling in joints
other then those in the spine.

10.  History And Physical Examinations
 Imaging Test [X-ray & MRI ]
 Blood Tests And Laboratory tests.

11.  Morning stiffness that last for more than 30
min of duration.
 Whether symptoms relieve on activity or
worsen with inactivity.
 Awakening because of the back pain during
the second part of night.
 If the patient experience alternative
buttocks pain.
 Family History.

12.  A Physical Examination may include the
following :-
 Joint Examinations- Assessing the Range of
Motion along the joints and the stiffness.
 Checking the Flexibility [Schober’s Test]
 Chest Expansion Test.

13. Finger to Floor Distance Test Lumbar Lateral Flexion Distance Test

14.  The examiner make mark at
the level of L5.
 The examiner then places
one finger 5cm below this
mark, and another, second
,finger 10cm above mark.
 The patient is asked to
touch his toes.
 By doing so, the dstance
between the two fingers of
the examiner increases.
 However the restriction in
the Lumber Flexion of the
patient reduces this
distances.
 If the distance increases
less than 5cm then there is
an indication is that the
flexion of lower back is
limited.

15.  It involves watching how he move and bend
in different directions.
 A tape is used to measure flexion and
extension of the lumbar spine.
 Limited motion in lower back is Symptomatic
of Ankylosing Spondylitis.
 The test is also known as modified Schober’s
Test.

17. Occiput-to-Wall Distance
Flesche Test
Tragus-to-Wall Distance Yest

18. Pelvic Compression Test Gaenslen Test

19. Cervical Spine Thoraco Lumbar Spine
 Forward Flexion- 0 to
45degree.
 Extension- 0 to
45degree.
 Lateral Flexion- 0 to
45degree.
 Lateral Rotation- 0 to
80degree.
 Forward Flexion- 0 to
90degree.
 Extension- 0 to
30degree.
 Lateral Flexion- 0 to
30degree.
 Lateral Rotation- 0 to
30degree.

20.  Chest expansion is measured by placing a
tape around the circumference of the chest
wall at the fourth intercostal space.
 Decreased Chest Expansion relative to
normal value for age and sex could indicate
Ankylosing Spondylitis.

22.  The patients may have to undergo one or
more of these blood tests:-
 Erythrocyte Sedimentation Rate [ESR].
 Elevate C-reactive Protein [CRP].
 HLA-B27 marker in Blood.
However, These tests have limited value in
determining disease activity.

23.  X-ray:-
 Helps to monitor disease progression and
joint damage . However it may take years
before the changes can be seen on
X-ray.
 MRI:-
 Helpful in early diagnosis of the disease as it
produced signals to create images for their
better analyzation of the joint.

25.  Eye Inflammation.
 Scarring and thickening of Lung tissue.
 Colitis or inflammation in the large intestine.
 Inability to control urination.
 Psoriasis [A skin disorder].
 The absence of normal reflexes in then
ankles.
 Low Bone density [Osteoporosis].

26.  The main goal of treatment is to maximize
the quality of life.
 Alleviation of pain.
 Retaining and recovery of physical functions.
 Delay of structural damage responsible for
Physical impairment.

27.  Drug treatment.
 Non Drug Treatment i.e Physiotherapy.
 Surgical Procedures.

28.  NSAIDs:- Aspirin, Ibuprofen
 Analgesic:- Acetaminophen
 Corticoticoseroids:- Decrease inflammation
and provide pain relief. Usually given as an
injection into the joint.
 Conventional Disease modifying Anti
Rheumatic Drugs [CMARDs]:-
 Not recommended for back pain.
 Considered for treating Peripheral Joints.
 Sulfasalazine.
 Biological Modifications:- TNF- α inhibitors.

29.  Physiotherapy includes:-
 Pain Management
 Regular Exercise
 Massage Therapy
 Patient Educations

30.  TENS
 UST
 IFT
 Hot packs , Hot Shower Bath
 Exercises

31. According to the American College of Sports
Medicine [ACDSM] recommendation exercise in
general are classified into 4 core categories:-
 Muscle Strengthening or Resistance Exercises.
 Aerobic Exercises.
 Flexibility Or Stretching Exercises.
 Neuromotor Skills Training.
-Balance and Cordinations.

32. WHO:-
recommends every adult should
accumulate atleast 150min of moderate
intensity Aerobic physical activity through out
the week or atleast 75min of Vigrous intensity
Aerobic exercise along with muscles
strengthening Exercises.

33.  Intervention to reduce pain using
Electrotherapy Modalities.
 Intervention to improve flexibility and spinal
mobility 10-15min to be practiced as a daily
basis.
-Stretching of the body muscles.
-Yoga
-Gymanastic Ball
-Sitting Crossed Legged

34.  Intervention to improve the muscle strength.
Muscles Strengthening Ex’s for Cervical
Spine, DorsoLumbar Spine, Shoulder, Hip,
Knee, Abdominal Muscles, Thoracic Rotators.
-Free weights
-Machines
-Thera bands
-Core Stability Ex’s
 Balancing training on a regular basis:
-One Leg Stances
-Stability Ball
-Strengthening Core Muscles. etc

35.  Press Up to Stretch Your Spine.
 Plank for a Stronger Core.
 Try Standing Leg Raises to Loosen Tight Hips.
 Do Chin Tucks to Stretch Your Neck.
 Roll Your Shoulders to Loosen Up.
 Stretch Your Hips to Ease Low Back Pain
 Corner Stretch to Open Your Chest
 Walk, Move.
 Take Deep Breaths.
Every exercise should be done 10 to 15 repetition holding
at least 5-10sec.

36.  Aims at alleviating pain and improving
mobility.
 Required in cases when joints are badly
affected.
 The knee and hip are the joints most often
replaced.
 The procedure is often done by an
experienced surgeons.

37.  General
- Maintain a proper posture at work, at
leisure and when sleeping.
- Avoid overtiring yourself.
- Avoid becoming overweight.
- Avoid Smoking.
- Maintain a Good attitude.
- Ergonomics.

38.  Routine checkup and Ex’s.
 Follow the treatment Plan.
 Stay Active with regular exercise.
 Maintain healthy diet.
 Practice good posture.
 Don’t smoke.