Join us for an enlightening seminar delving into the intricate world of Ankylosing Spondylitis (AS). This event aims to provide a deep understanding of AS, a chronic inflammatory arthritis primarily affecting the spine and pelvis.
Seminar Highlights:
Introduction to Ankylosing Spondylitis:
Definition, prevalence, and demographic insights.
Clinical Features and Diagnosis:
Recognizing early symptoms and the diagnostic journey.
The role of imaging and laboratory tests.
Understanding the Pathophysiology:
In-depth exploration of the immune system's role.
Genetic factors and their impact on AS.
Treatment Modalities:
Current pharmacological interventions.
Physical therapy and lifestyle management.
Quality of Life and Mental Health:
Addressing the holistic impact of AS on daily life.
Strategies for maintaining mental and emotional well-being.
Research Advances and Future Directions:
Overview of cutting-edge research in AS.
Promising avenues for future treatments and interventions.
This document provides information on Ankylosing Spondylitis (AS), including:
- It is an inflammatory arthritis affecting the spine and sacroiliac joints, causing stiffness and fusion of the joints. HLA-B27 gene and TNF play a role in its pathogenesis.
- Signs and symptoms include back pain, limited spinal mobility, chest expansion and peripheral joint involvement. Imaging shows bone erosion and formation in affected areas.
- Treatment involves exercise, NSAIDs, and biologics targeting TNF. Surgery may be needed in advanced cases to correct deformities.
The document discusses seronegative spondyloarthropathies, a group of disorders that share clinical features like inflammatory axial arthritis and enthesitis. It focuses on ankylosing spondylitis (AS), describing its pathology, clinical manifestations including stiffness and fusion of the spine, extra-articular involvement like uveitis, and treatments including NSAIDs and TNF inhibitors. Surgical treatments for severe AS spinal deformities like osteotomies and joint replacement are also summarized.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints. It is characterized by inflammation of the entheses, where ligaments and tendons attach to bone. Over time, this leads to ossification and fusion of the vertebrae (bamboo spine). Symptoms include chronic lower back pain and stiffness, especially early morning, as well as restricted spinal mobility. Diagnosis is based on clinical features and confirmed by presence of HLA-B27 and imaging showing sacroiliitis and vertebral squaring/syndesmophytes. There is currently no cure for ankylosing spondylitis, but treatment can help reduce symptoms and prevent deformity.
This document provides an overview of spinal stenosis. It defines spinal stenosis as abnormal narrowing of the central canal, lateral recess, or intervertebral foramina that compromises neural elements. The document discusses the pathogenesis, classification, types, anatomy, pathology, natural history, clinical features, diagnosis, and treatment options for spinal stenosis. Treatment options include non-operative approaches like rest, pain management, and epidural steroid injections, as well as operative procedures. Imaging plays an important role in diagnosis and includes X-rays, CT, MRI, and CT myelography.
This document discusses seronegative arthritis, specifically focusing on spondyloarthropathies. It defines spondyloarthropathies as a group of inflammatory arthropathies that share clinical, radiographic, and genetic features, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It then provides detailed information on the pathogenesis, clinical manifestations, diagnostic findings, and treatment approaches for ankylosing spondylitis and reactive arthritis. Psoriatic arthritis is also briefly discussed.
This document provides an overview of osteoarthritis (OA), including:
- OA is a degenerative disease affecting synovial joints, characterized by loss of articular cartilage and new bone growth.
- It most commonly impacts weight-bearing joints like the knee and hip. Risk factors include age, genetics, mechanical factors.
- Symptoms include pain worsened by activity and relieved by rest, morning stiffness under 30 minutes, and functional limitations. Diagnosis is based on clinical features and confirmed by x-rays.
- Treatment includes patient education, exercises, weight loss, medications like paracetamol, NSAIDs, and corticosteroid injections. Surgery is considered if other treatments are
This document provides information on Ankylosing Spondylitis (AS), including:
- It is an inflammatory arthritis affecting the spine and sacroiliac joints, causing stiffness and fusion of the joints. HLA-B27 gene and TNF play a role in its pathogenesis.
- Signs and symptoms include back pain, limited spinal mobility, chest expansion and peripheral joint involvement. Imaging shows bone erosion and formation in affected areas.
- Treatment involves exercise, NSAIDs, and biologics targeting TNF. Surgery may be needed in advanced cases to correct deformities.
The document discusses seronegative spondyloarthropathies, a group of disorders that share clinical features like inflammatory axial arthritis and enthesitis. It focuses on ankylosing spondylitis (AS), describing its pathology, clinical manifestations including stiffness and fusion of the spine, extra-articular involvement like uveitis, and treatments including NSAIDs and TNF inhibitors. Surgical treatments for severe AS spinal deformities like osteotomies and joint replacement are also summarized.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints. It is characterized by inflammation of the entheses, where ligaments and tendons attach to bone. Over time, this leads to ossification and fusion of the vertebrae (bamboo spine). Symptoms include chronic lower back pain and stiffness, especially early morning, as well as restricted spinal mobility. Diagnosis is based on clinical features and confirmed by presence of HLA-B27 and imaging showing sacroiliitis and vertebral squaring/syndesmophytes. There is currently no cure for ankylosing spondylitis, but treatment can help reduce symptoms and prevent deformity.
This document provides an overview of spinal stenosis. It defines spinal stenosis as abnormal narrowing of the central canal, lateral recess, or intervertebral foramina that compromises neural elements. The document discusses the pathogenesis, classification, types, anatomy, pathology, natural history, clinical features, diagnosis, and treatment options for spinal stenosis. Treatment options include non-operative approaches like rest, pain management, and epidural steroid injections, as well as operative procedures. Imaging plays an important role in diagnosis and includes X-rays, CT, MRI, and CT myelography.
This document discusses seronegative arthritis, specifically focusing on spondyloarthropathies. It defines spondyloarthropathies as a group of inflammatory arthropathies that share clinical, radiographic, and genetic features, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It then provides detailed information on the pathogenesis, clinical manifestations, diagnostic findings, and treatment approaches for ankylosing spondylitis and reactive arthritis. Psoriatic arthritis is also briefly discussed.
This document provides an overview of osteoarthritis (OA), including:
- OA is a degenerative disease affecting synovial joints, characterized by loss of articular cartilage and new bone growth.
- It most commonly impacts weight-bearing joints like the knee and hip. Risk factors include age, genetics, mechanical factors.
- Symptoms include pain worsened by activity and relieved by rest, morning stiffness under 30 minutes, and functional limitations. Diagnosis is based on clinical features and confirmed by x-rays.
- Treatment includes patient education, exercises, weight loss, medications like paracetamol, NSAIDs, and corticosteroid injections. Surgery is considered if other treatments are
The document discusses the clinical evaluation of patients with spine disorders. A thorough history and physical examination is important to identify potential pain generators and prognostic factors. The physical exam includes assessment of alignment, gait, palpation, neurological function, motor strength, reflexes, and special tests. Differential diagnoses include musculoskeletal, radicular, and spinal cord issues. A biopsychosocial approach is emphasized to understand how anatomical, psychological, and social factors all contribute to a patient's pain experience and prognosis.
Tuberculosis of the hip is a rare form of skeletal tuberculosis that can lead to significant deformity if not treated properly. It typically begins as a tuberculous synovitis that can progress to arthritis and destruction of the hip joint if left untreated. Treatment involves a combination of anti-tubercular medications for at least one year as well as rest and traction to prevent deformities. For more advanced cases, surgical procedures like synovectomy, osteotomies or arthrodesis may be needed. With adequate treatment, outcomes can be good, especially if caught early, but significant deformity can negatively impact function.
This document provides an overview of osteoarthritis (OA). It begins with protective mechanisms of synovial joints and defines OA as a degenerative disease involving cartilage loss, new bone growth, and joint contour changes. Risk factors include age, genetics, and mechanical factors. Clinically, OA causes pain worsened by activity that improves with rest, morning stiffness under 30 minutes, and functional limitations. Investigations show joint space narrowing on x-rays. Management includes patient education, exercises, medications like paracetamol, NSAIDs, opioids, and corticosteroid injections, as well as surgery for advanced cases.
This document provides an overview of osteoarthritis (OA), including:
- OA is a degenerative disease affecting synovial joints, characterized by loss of cartilage and new bone growth.
- It most commonly impacts weight-bearing joints like the knee and hip. Risk factors include age, genetics, mechanical factors.
- Clinically, OA presents with pain worsened by activity that improves with rest, morning stiffness under 30 minutes, and functional limitations. Investigations include x-rays showing joint space narrowing.
- Management involves patient education, exercises, weight loss, medications like paracetamol, NSAIDs, opioids, corticosteroid injections, hyaluronic acid injections,
1. The document describes various conditions affecting the shoulder joint complex including impingement syndrome, rotator cuff tears, rotator cuff arthropathy, calcifying tendonitis, and shoulder instabilities.
2. It also discusses examination of the shoulder joint including inspection, palpation, range of motion testing, and special tests. Common elbow conditions such as cubitus varus/valgus, instability, and overuse syndromes are also summarized.
3. Examination of the elbow joint involves inspection, palpation, and assessing range of motion.
The document summarizes an orthopaedics seminar on skeletal tuberculosis. It discusses the epidemiology, pathogenesis, clinical features, investigations and management of skeletal tuberculosis. Key points include that tuberculosis can affect bones and joints secondary to a primary lung or lymph node infection. Spinal tuberculosis is most common, often affecting the pediatric population. Diagnosis involves x-rays, biopsy and culture. Treatment consists of antibiotic therapy for 9-24 months as well as surgery if needed to drain abscesses, debride joints or stabilize bones.
Spinal tuberculosis and spinal infectionsVijay Anand
Tuberculosis of the spinal column, also known as Pott's disease, is caused by infection with Mycobacterium tuberculosis bacteria. It most commonly affects the lower thoracic and thoracolumbar regions of the spine. Clinical features include back pain, spinal deformity, and possible paralysis. Diagnosis involves x-rays, CT scans, MRI, and microbiological testing. Treatment consists of a lengthy multi-drug antibiotic regimen lasting 18 months or longer to prevent disability and complications like abscesses. Proper treatment is important to avoid development of multi-drug resistant tuberculosis strains.
This document provides an overview of ankylosing spondylitis (AS), including its definition, epidemiology, etiology, pathogenesis, clinical manifestations, investigations, and management. Some key points:
- AS is a chronic inflammatory disease affecting the axial skeleton and sacroiliac joints that can lead to fusion and rigidity of the spine. It has strong genetic associations with HLA-B27.
- Symptoms include lower back pain and stiffness that typically worsens in the morning. Advanced cases can develop a fixed "question mark" posture.
- Investigations include blood tests, imaging like X-rays and MRI to assess sacroiliac joint involvement, and mobility tests. HLA-B27
Congenital anomalies and degenerative conditions of vertebraBipulBorthakur
This document summarizes CT findings related to congenital anomalies, infections, and degenerative conditions of the spine. It describes common congenital anomalies such as spina bifida occulta, coronal cleft vertebra, and block vertebra. It also discusses spinal infections including bacterial spondylodiskitis caused by pathogens like Staphylococcus aureus and tuberculous spondylitis. Finally, it reviews degenerative changes in the spine seen with aging and conditions like ankylosing spondylitis. CT is useful for evaluating bony abnormalities, spinal infections, and the extent of fusion in diseases like ankylosing spondylitis.
Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine. It causes back pain and stiffness, and can result in fusion of the vertebrae. Physical therapy for AS aims to reduce pain and stiffness, improve posture and mobility, and prevent deformities. Treatment involves exercises to increase flexibility, strength, and lung capacity. Stretches and strengthening exercises target affected areas like the neck, back, hips and ribs. Hydrotherapy can also help improve mobility and function while easing symptoms during flares. The goals are maintaining normal function and mobility to improve quality of life.
Spondyloarthropathies By Dr Rekha Vankwani.pptxZOHAIB57
1. Sero-negative arthritis refers to types of inflammatory arthritis that are negative for rheumatoid factor and other autoantibodies. These include spondyloarthropathies like ankylosing spondylitis.
2. Ankylosing spondylitis is a chronic inflammatory disorder affecting the spine and sacroiliac joints. It is strongly associated with the HLA-B27 gene. Symptoms include back pain and stiffness that improves with exercise.
3. Treatment involves NSAIDs, TNF inhibitors, exercise and maintaining posture. Surgery may be used for joint replacement.
1) Acute pyogenic arthritis is a bacterial infection of the synovial membrane that leads to purulent effusion in the joint capsule. It is considered a rheumatologic emergency as joint destruction can occur rapidly.
2) Common causative organisms are Staphylococcus and Streptococcus bacteria. The knee is the most commonly infected joint. Clinical features include fever, pain, swelling and reduced range of motion in the affected joint.
3) Treatment involves antibiotics, drainage of purulent material from the joint, and physiotherapy. Without prompt treatment, complications can include joint damage, deformity and ankylosis. Prognosis depends on factors like the infected joint, age and delay in treatment.
Ankylosing spondylitis is a chronic inflammatory arthritis characterized by fusion of the spine. It causes pain and stiffness in the low back and neck that worsens with inactivity. The condition is associated with the HLA-B27 gene and often presents in early adulthood. Over time, inflammation leads to bone formation that fuses the vertebrae, resulting in a "bamboo spine". Treatment focuses on maintaining posture and chest expansion through exercises to prevent spinal deformity.
This document provides an overview of common elbow disorders presented by Dr. Farouq Makkie Alyouzbaki. It discusses the anatomy of the elbow joint and various conditions affecting the elbow including cubitus varus, cubitus valgus, pulled elbow, osteochondritis disse cans, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), and olecranon bursitis. For each condition, it describes the causes, signs, symptoms, management options including both conservative and surgical treatments. The goal is to educate on evaluating and managing a variety of elbow disorders.
This document discusses bone and joint tuberculosis, providing details on locations, clinical features, investigations, imaging, management, and follow up. It notes that spine and hip tuberculosis are most common, and describes characteristics of tuberculosis in various bones and joints. Imaging modalities like MRI, CT, X-ray, and PET CT are outlined. Surgical indications and conservative treatment including drug therapy are summarized.
This document discusses assessment and rehabilitation for spondyloarthropathy. It begins by defining spondyloarthropathy as a group of inflammatory disorders affecting the spine and joints. It then focuses on ankylosing spondylitis (AS) and describes its characteristics, epidemiology, signs and symptoms, diagnostic criteria, treatments including NSAIDs, DMARDs, anti-TNF therapy, exercises and rehabilitation. The goal of treatment is to reduce symptoms and maintain spinal flexibility through non-pharmacological and pharmacological approaches.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
The document discusses the clinical evaluation of patients with spine disorders. A thorough history and physical examination is important to identify potential pain generators and prognostic factors. The physical exam includes assessment of alignment, gait, palpation, neurological function, motor strength, reflexes, and special tests. Differential diagnoses include musculoskeletal, radicular, and spinal cord issues. A biopsychosocial approach is emphasized to understand how anatomical, psychological, and social factors all contribute to a patient's pain experience and prognosis.
Tuberculosis of the hip is a rare form of skeletal tuberculosis that can lead to significant deformity if not treated properly. It typically begins as a tuberculous synovitis that can progress to arthritis and destruction of the hip joint if left untreated. Treatment involves a combination of anti-tubercular medications for at least one year as well as rest and traction to prevent deformities. For more advanced cases, surgical procedures like synovectomy, osteotomies or arthrodesis may be needed. With adequate treatment, outcomes can be good, especially if caught early, but significant deformity can negatively impact function.
This document provides an overview of osteoarthritis (OA). It begins with protective mechanisms of synovial joints and defines OA as a degenerative disease involving cartilage loss, new bone growth, and joint contour changes. Risk factors include age, genetics, and mechanical factors. Clinically, OA causes pain worsened by activity that improves with rest, morning stiffness under 30 minutes, and functional limitations. Investigations show joint space narrowing on x-rays. Management includes patient education, exercises, medications like paracetamol, NSAIDs, opioids, and corticosteroid injections, as well as surgery for advanced cases.
This document provides an overview of osteoarthritis (OA), including:
- OA is a degenerative disease affecting synovial joints, characterized by loss of cartilage and new bone growth.
- It most commonly impacts weight-bearing joints like the knee and hip. Risk factors include age, genetics, mechanical factors.
- Clinically, OA presents with pain worsened by activity that improves with rest, morning stiffness under 30 minutes, and functional limitations. Investigations include x-rays showing joint space narrowing.
- Management involves patient education, exercises, weight loss, medications like paracetamol, NSAIDs, opioids, corticosteroid injections, hyaluronic acid injections,
1. The document describes various conditions affecting the shoulder joint complex including impingement syndrome, rotator cuff tears, rotator cuff arthropathy, calcifying tendonitis, and shoulder instabilities.
2. It also discusses examination of the shoulder joint including inspection, palpation, range of motion testing, and special tests. Common elbow conditions such as cubitus varus/valgus, instability, and overuse syndromes are also summarized.
3. Examination of the elbow joint involves inspection, palpation, and assessing range of motion.
The document summarizes an orthopaedics seminar on skeletal tuberculosis. It discusses the epidemiology, pathogenesis, clinical features, investigations and management of skeletal tuberculosis. Key points include that tuberculosis can affect bones and joints secondary to a primary lung or lymph node infection. Spinal tuberculosis is most common, often affecting the pediatric population. Diagnosis involves x-rays, biopsy and culture. Treatment consists of antibiotic therapy for 9-24 months as well as surgery if needed to drain abscesses, debride joints or stabilize bones.
Spinal tuberculosis and spinal infectionsVijay Anand
Tuberculosis of the spinal column, also known as Pott's disease, is caused by infection with Mycobacterium tuberculosis bacteria. It most commonly affects the lower thoracic and thoracolumbar regions of the spine. Clinical features include back pain, spinal deformity, and possible paralysis. Diagnosis involves x-rays, CT scans, MRI, and microbiological testing. Treatment consists of a lengthy multi-drug antibiotic regimen lasting 18 months or longer to prevent disability and complications like abscesses. Proper treatment is important to avoid development of multi-drug resistant tuberculosis strains.
This document provides an overview of ankylosing spondylitis (AS), including its definition, epidemiology, etiology, pathogenesis, clinical manifestations, investigations, and management. Some key points:
- AS is a chronic inflammatory disease affecting the axial skeleton and sacroiliac joints that can lead to fusion and rigidity of the spine. It has strong genetic associations with HLA-B27.
- Symptoms include lower back pain and stiffness that typically worsens in the morning. Advanced cases can develop a fixed "question mark" posture.
- Investigations include blood tests, imaging like X-rays and MRI to assess sacroiliac joint involvement, and mobility tests. HLA-B27
Congenital anomalies and degenerative conditions of vertebraBipulBorthakur
This document summarizes CT findings related to congenital anomalies, infections, and degenerative conditions of the spine. It describes common congenital anomalies such as spina bifida occulta, coronal cleft vertebra, and block vertebra. It also discusses spinal infections including bacterial spondylodiskitis caused by pathogens like Staphylococcus aureus and tuberculous spondylitis. Finally, it reviews degenerative changes in the spine seen with aging and conditions like ankylosing spondylitis. CT is useful for evaluating bony abnormalities, spinal infections, and the extent of fusion in diseases like ankylosing spondylitis.
Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine. It causes back pain and stiffness, and can result in fusion of the vertebrae. Physical therapy for AS aims to reduce pain and stiffness, improve posture and mobility, and prevent deformities. Treatment involves exercises to increase flexibility, strength, and lung capacity. Stretches and strengthening exercises target affected areas like the neck, back, hips and ribs. Hydrotherapy can also help improve mobility and function while easing symptoms during flares. The goals are maintaining normal function and mobility to improve quality of life.
Spondyloarthropathies By Dr Rekha Vankwani.pptxZOHAIB57
1. Sero-negative arthritis refers to types of inflammatory arthritis that are negative for rheumatoid factor and other autoantibodies. These include spondyloarthropathies like ankylosing spondylitis.
2. Ankylosing spondylitis is a chronic inflammatory disorder affecting the spine and sacroiliac joints. It is strongly associated with the HLA-B27 gene. Symptoms include back pain and stiffness that improves with exercise.
3. Treatment involves NSAIDs, TNF inhibitors, exercise and maintaining posture. Surgery may be used for joint replacement.
1) Acute pyogenic arthritis is a bacterial infection of the synovial membrane that leads to purulent effusion in the joint capsule. It is considered a rheumatologic emergency as joint destruction can occur rapidly.
2) Common causative organisms are Staphylococcus and Streptococcus bacteria. The knee is the most commonly infected joint. Clinical features include fever, pain, swelling and reduced range of motion in the affected joint.
3) Treatment involves antibiotics, drainage of purulent material from the joint, and physiotherapy. Without prompt treatment, complications can include joint damage, deformity and ankylosis. Prognosis depends on factors like the infected joint, age and delay in treatment.
Ankylosing spondylitis is a chronic inflammatory arthritis characterized by fusion of the spine. It causes pain and stiffness in the low back and neck that worsens with inactivity. The condition is associated with the HLA-B27 gene and often presents in early adulthood. Over time, inflammation leads to bone formation that fuses the vertebrae, resulting in a "bamboo spine". Treatment focuses on maintaining posture and chest expansion through exercises to prevent spinal deformity.
This document provides an overview of common elbow disorders presented by Dr. Farouq Makkie Alyouzbaki. It discusses the anatomy of the elbow joint and various conditions affecting the elbow including cubitus varus, cubitus valgus, pulled elbow, osteochondritis disse cans, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), and olecranon bursitis. For each condition, it describes the causes, signs, symptoms, management options including both conservative and surgical treatments. The goal is to educate on evaluating and managing a variety of elbow disorders.
This document discusses bone and joint tuberculosis, providing details on locations, clinical features, investigations, imaging, management, and follow up. It notes that spine and hip tuberculosis are most common, and describes characteristics of tuberculosis in various bones and joints. Imaging modalities like MRI, CT, X-ray, and PET CT are outlined. Surgical indications and conservative treatment including drug therapy are summarized.
This document discusses assessment and rehabilitation for spondyloarthropathy. It begins by defining spondyloarthropathy as a group of inflammatory disorders affecting the spine and joints. It then focuses on ankylosing spondylitis (AS) and describes its characteristics, epidemiology, signs and symptoms, diagnostic criteria, treatments including NSAIDs, DMARDs, anti-TNF therapy, exercises and rehabilitation. The goal of treatment is to reduce symptoms and maintain spinal flexibility through non-pharmacological and pharmacological approaches.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
5. WHY ARE THEY GROUPED
TOGETHER?
• Genetic basis
• Environmental trigger like GIT & GUI
• Spine
• Oligoarthritis of Large Joints
• Enthesitis (inflammation of site of insertion of
tendons and ligaments into bone
• New aberrant bone formation along with bone loss
5
ANK.
SPOND
6. DEFINITION
Ankylosing spondylitis is a potentially disabling
inflammatory arthritis of the spine, usually presenting
as chronic back pain, typically before age of 45yrs.
Often associated with extraspinal and extra-articular
features.
6
ANK.
SPOND
7. EPIDEMIOLOGY
ANK.
SPOND
7
• Incidence and prevalence correlate with frequency of HLA-B27 in the
population
• 6-9% in population
• Out of the HLA-B27 positive individual 5-7% will develop Ankylosing
spondylitis.
• On the other hand 80-95% of Ankylosing spondylitis shall have HLA-B27
positivity
• Shows wide geographical variation in occurrence across region and race
• 31.9 per 10,000 population in US
• While 7 per 10,000 population in India
• AS and HLA-B27 are nearly absent (<1%) in African blacks and Japanese
Population
9. GENETIC FACTOR
ANK.
SPOND
9
• Genetic factors have Overwhelming importance
• Relative Risk of AS in:
• First degree- 94
• Second degree- 25
• Third degree- 4
10. GENETICS CONT..
• HLA-B27
• First recognised in 1973
• Strongest association with disease
• Overall contribution to AS heritability is approximately 20%
• Most frequent subtype are HLA-B2705 and HLA-B2704
• Only two subtypes are considered not to be associated- HLA-B2706 and HLA-
B2709
1 0
ANK.
SPOND
13. GUT MICROBIOME
• Total number of Micro-organisms,
(bacteria, viruses, protozoa and fungi) and
their collective genetic material living in
our GIT
• Normally the microbiome is separated
from host by the gut epithelial barrier and
gut vascular barrier
• However, when the integrity of the
barriers is compromised the microbes
become capable of initiating a systemic
immune response.
1 3
ANK.
SPOND
14. • Composition of Gut Microbiome is influenced by genetic and other factors.
• Differs in AS patients from healthy individuals
1 4
ANK.
SPOND
15. MECHANICAL STRESS
• In AS, inflammation is observed mostly in
anatomic regions subjected to mechanical stress
• Axial skeleton, Joints of lower limbs, heels,
especially at entheses
• Studies indicate that mechanical stress activates
mesenchymal cells to release chemokines which
attract inflammatory cells towards these
entheses
1 5
ANK.
SPOND
16. COEXISTING BONE EROSION AND
NEW BONE FORMATION
• Still not fully understood.
• Initial changes is
inflammation in which
cytokines such as TNF and IL-
17 directly or indirectly
activates osteoclast precursor
cells.
• Thus flexibility is lost.
1 6
ANK.
SPOND
18. • Inflammatory backpain
• Corresponds to location of Sacro-iliac joint (back pocket of trouser)
• Alternates between two sides but sometimes remains only one sided.
• Frequently but not invariably has characteristics of inflammatory
nature
• Typically before 40yrs
• Often associated with extraspinal features like peripheral
arthritis, enthesitis and dactylitis.
• May also be associated with extra-articular features like
uveitis, psoriasis and inflammatory bowel disease.
1 8
ANK.
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19. ASSESSMENTS OF SPONDYLARTHRITIS
INTERNATIONAL SOCIETY (ASAS) CRITERIA
• For inflammatory backpain.
• At least four of the five features to be positive:
• Age <40 years
• Insidious Onset
• Improvement with exercise
• No improvement with rest
• Pain at night. (can’t turn at night)
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20. CLUES TO BACKPAIN
SUGGESTIVE OF
INFLAMMATORY DISEASE
• Early onset <40yrs
• Gradual onset
• Morning stiffness
• Improvements with exercise
• Early morning awakening
• Alternating buttocks
• Uveitis, Mouth ulcers, Inflammatory
peripheral arthritis, Urethritis,
Psoriasis, IBD
NOT SUGGESTIVE OF
INFLAMMATORY DISEASE
• Older age >40yrs
• Abrupt onset
• H/O trauma, Cancer
• Radiculopathy
• Weight loss, Generalized aching
• Night Sweats
• Fever
• Worsen with exercise
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21. CAN BE CLASSIFIED AS TWO
SUBTYPES
RADIOGRAPHIC AXIAL
SPONDYLOARTHRITIS
SI joint changes and Xray changes
present
NON RADIOGRAPHIC AXIAL
SPONDYLOARTHRITIS
Only MRI changes are present
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22. OTHER MUSCULOSKELETAL
FEATURES
• Groin Pain: Hip arthritis and shoulder joint involvement
• Chest and Neck Pain: Costovertebral, manubriosternal, sternoclavicular and
costochondral inflammation
• Restricted Spinal Mobility: Inflammation of extraspinal entheses
• Dactylitis
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23. OTHER FEATURES
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ENTHESES AT
ACHILLES TENDON
SAUSAGE DIGIT
(6%)
Diffuse swelling of toes
and fingers
HYPERKYPHOSIS OF
BACK (HUNCH
BACK)
Flexion deformity of
neck
Thoracic wedging hyper
kyphosis
Loss of normal lumbar
lordosis
Flexion deformity of the
hip
25. EXTRA-ARTICULAR MANIFESTATION
• Fatigue weight loss
• Anterior uveitis 25-30% with longer disease (acute ocular pain later glaucoma or
cataract)
• Inflammatory Bowel disease 50% cases but rarely clinical
• Psoriasis 10% cases with peripheral joints but weaker association with HLA-B 27
• Psychosocial Issue with depression and sleep disorder
• Cardiovascular risk for IHD, ACS, strokes, VTE
• Pulmonary changes like fibrosis
• Neurological features due to PLL ossification, instability leading to even cauda
equina syndrome and in some cases arachnoiditis
• Renal involvement as IgA nephropathy, Haematuria and Amyloidosis later
• Osteoporosis is seen early with symptomatic osteoporotic fractures
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28. TRAGUS WALL
DISTANCE
• Patients heel and back rests on the
wall with no flexion and extension
at knee or hip
• Chin usually at the usual carrying
level. Maximum effort to touch the
head against the wall
• Report the better of two tries
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30. CERVICAL
ROTATIONS
• Patient sits straight on chair, chin
level, hands on knees
• Assessor places goniometer on the
top of the head in line with the
nose (A)
• The assessor asks to rotate the
neck maximally to left, follows with
goniometer and records the angle
in between the sagittal plane and
the new plane after rotation (B)
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31. CHEST WALL
EXPANSION
• Patients hands resting on or
behind the head
• Measure at 4th IC level anteriorly
or just below nipple in females
• The difference between maximal
inspiration and expiration in cms is
recorded
• ~5cms
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32. MODIFIED
SCHOBER’S TEST
• Patient should be erect. Make an
imaginary line connecting both
posterior superior iliac spines
(close to the dimples of venus (A)
• Next mark 10cms above (B).
• The patient bends forward
maximally (without bending the
knee) measure the difference (C)
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33. LUMBAR FLEXION
TEST
• Using a goniometer parallel to the
spine and asking the patient to
flex laterally on either side and the
angle subtended is measured.
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34. INTERMALLEOLAR
DISTANCE
• Patient lying down supine and the
legs are separated with knees
straight and toes pointing upwards
• Alternatively the patient stands
and the legs are separated as far
as possible
• Distance between medial malleoli
measures
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36. LAB FINDINGS
• Elevated ESR and CRP in approximately 50-70%
• Less frequent with non radiographic axial spondylitis patient (30%)
• Normochromic normocytic anemia in very active patients
• Serum bone specific alkaline phosphatase may be elevated
• Synovial fluid findings are typical of inflammatory arthritis
• HLA B 27 is present in 80-95%
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37. RADIOLOGIC FEATURES
SACROILIITIS
• Erosions
• Ankylosis
• Juxta articular osteopenia
• Ossification of ligamentous
attachment to the ischial tuberosity
or the iliac crest or the GT
SPINE
• Erosions of vertebral corners (Shiny
Corners)
• Squaring of vertebral bodies
(Romanus Lesion)
• Syndesmophytes
• Ossification of Annulus fibrosis and
Longitudinal Ligaments
• Erosion of disco-vertebral junction
• Pseudoarthrosis
• Juxta articular bone oedema
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38. IMAGING
• sacroiliitis is usually the first manifestation and is
symmetrical and bilateral
• the sacroiliac joints first widen before they
narrow
• subchondral erosions, sclerosis, and
proliferation on the iliac side of the SI joints
• at end-stage, the SI joint may be seen as a thin
line or not visible
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39. NEW YORK CRITERIA
• grade 0: normal
• grade I: suspicious changes (some blurring of the joint margins)
• grade II: minimum abnormality (small localized areas with erosion or sclerosis,
with no alteration in the joint width)
• grade III: unequivocal abnormality (moderate or advanced sacroiliitis with
erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis)
• grade IV: severe abnormality (complete ankylosis)
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41. MRI CHANGES OF SACROILIAC
JOINT
• Bone marrow
oedema, fatty
changes and
structural changes can
be picked up
• Important in Non
Radiographical Axial
spondylitis
• False positive finding
might be present with
healthy individuals
(female and post
partum period)
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42. CT CHANGES
• More sensitive than
Xray
• Low Radiation Ct is
sufficient
• Limitation of CT
include the inability to
assess the activity of
inflammation
• Better to see marginal
erosions
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43. PREDICTORS FOR RADIOGRAPHIC
PROGRESSION OF SACROILIITIS
• Human Leukocyte Antigen (HLA)-B27 positivity
• Smoking
• Male Sex
• Elevated C-Reactive Protein (CRP)
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44. SPINE RADIOGRAPH
• Best imaging in lateral view
• Squaring of vertebral bodies due to anterior
and posterior inflammation and bone erosion
and deposition is relatively early radiographic
signs of spinal involvement in AS
• Syndesmophytes
• Shiny corner sign: AKA Romanus Lesions
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47. HIPS
• Hip involvement is generally bilateral
and symmetric
• Uniform joint space narrowing,
• Axial migration of the femoral head
sometimes reaching a state
of protrusio acetabuli, and
• A collar of osteophytes at the femoral
head-neck junction.
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48. PELVIS
• Whiskering of the pelvic bones
primarily affects the ischial
tuberosities, resulting from
ossification of the ligamentous
origins.
• There can be bridging or fusion
of the pubic symphysis.
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56. PHARMACOLOGIC
• NSAIDS
• Conventional DMARDS (csDMARDs)
• Biological DMARDS (bDMARDs)
• No role of Low dose glucocorticoids but intra-articular injections may be
helpful in selected patients.
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57. NON PHARMACOLOGIC
• Patient Education:
• Need for lifelong exercise and posture training program
• Importance of regular follow up and management of comorbidities
• Smoking cessation
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58. PHYSICAL THERAPY
• Range of Motion exercises
• Stretching
• Recreational activities
• Hydrotherapy
• Spinal manipulation should be avoided in patients with spinal fusion or
advanced spinal osteoporosis
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59. PRE-TREATMENT EVALUATION
• Baseline CBC, Sr Creat., LFT, ESR, CRP
• Hep B and Hep C screening must be done before starting DMARDS
• Testing for latent TB- Mantoux or IGRA must be done before starting
DMARDS
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64. bDMARD
• IL-17 Antagonists: Secukinumab
Ixekizumab
• To be avoided in patients with concomitant IBD (may cause flare up)
• S/E:
• Hypersensitivity
• Increased risk of infections
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65. 2019 UPDATE OF THE AMERICAN COLLEGE OF
RHEUMATOLOGY/SPONDYLITIS ASSOCIATION OF
AMERICA/SPONDYLARTHRITIS RESEARCH AND
TREATMENT NETWORK RECOMMENDATIONS FOR
THE TREATMENT OF ANKYLOSING SPONDYLITIS
AND NON-RADIOGRAPHIC AXIAL
SPONDYLARTHRITIS
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68. GENERAL PRINCIPLES
• Severe hip and knee arthritis can be managed by TKR and THR respectively
• If flexion deformity is severe the patient’s field of vision is limited to a small
area near the feet and walking is extremely difficult
• This is evident by looking at the chinbrow to vertical angle
• Respiration becomes almost completely diaphragmatic
• Gastrointestinal symptoms resulting from pressure of the costal margin on
the contents of the upper abdomen are common: dysphagia or choking may
occur
• In addition to improvement in function the improvement in appearance
made by correcting the deformity is important to the patients
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69. • If extreme the deformity should be corrected in two or more stages because
of the contracture of soft tissue and the danger of damaging the aorta,
inferior vena cava and the major nerves to the lower extremities
• According to Law, 25-40 degrees of correction usually obtained resulting in
marked improvement functionally and cosmetically
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70. OSTEOTOMIES FOR SPINE
• Smith Peterson Osteotomy
• Pedicle subtraction Osteotomy (Thomasen)
• Eggshell Osteotomy
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71. SMITH PETERSON
OSTEOTOMY
• For correction of smaller degrees of spinal degree
• Bone is removed through the pars and facet joints
• Symmetrical resection is necessary to prevent creating a coronal deformity
• Removal of underlying ligament also is helpful in preventing buckling of the
dura or iatrogenic spinal stenosis
• Approximately 10 degrees of correction can be obtained with each 10mm of
resection
• Excessive resection should be avoided because it may result in foraminal
stenosis
• In patients with degenerative discs decreased flexibility may limit the amount
of correction that can be obtained
• Osteotomy is closed with compression or with in situ rod contouring and
bone graft is applied.
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72. PEDICLE SUBTRACTION
OSTEOTOMY
• Best suited for patients with significant sagittal imbalance of 4cm or more
and immobilize or fused discs
• Pedicle subtraction osteotomy is inherently safer than the Smith Peterson as
it avoids multiple surgeries
• Typically 30 degrees or more of correction can be obtained with single
posterior osteotomy preferably at the level of the deformity
• If the deformity is at the spinal cord level pedicle subtraction osteotomy can
be used but manipulation of the cord must be avoided
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73. EGG-SHELL OSTEOTOMY
• Requires both anterior and posterior approach and usually reserved for
severe sagittal or coronal imbalance of more than 10cms from the midline
• This is spinal shortening procedure with anterior decancellisation followed by
removal of posterior elements, instrumentation, deformity correction and
fusion
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74. OSTEOTOMY FOR CERVICAL
SPINE
• Doen in patients with chin to chest with difficult mandibular opening
• May be indicated:
• To elevate chin from sternum improving ability to see and eat
• Prevent atlantoaxial and cervical subluxation and dislocation, which results in weight of
the head being carried forward by gravity
• Relieve tracheal or oesophageal distortion
• Prevent irritation of spinal cord tracts causing neurological disturbance
• Level of osteotomy is decided by degree of ossification by ALL
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76. JUVENILE AS
• Before 16 yrs, more common in males
• 80% prevalence of HLA- B27
• Axial skeletal involvement seen in only 12% cases and peripheral arthropathy
in 78-85%
• Lower limb joints frequently affected
• 5-10% may have constitutional symptoms of anemia increased ESR
gypergammaglobulinemia
• CVS and respiratory diseases are uncommon
• Subluxation of Atlanto-axial joints leading to severe cervico-occipital pain
• High level of IgM, IgG are found in both the patients and their 1st degree
relatives and selective deficiency of IgA has been reported.
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Bone scans don’t help as there is syndesmophytes giving false values
9.5cm
0cm
80° to 90° of flexion, 70° of extension, 20° to 45° of lateral flexion, and up to 90° of rotation to both sides.
15-20cms
20degrees
Xray normal cant be diagnosed even early onset is lost
Score >4 is positive
Others Like ASDAS BASMI
Interferron Gamma release assay
Mtx Sulfasalazine and Leflunamide used in peripheral Ank Spond
Sulfa reduces use of NSAIDS
Infliximab: Infusions every 6 weeks after 3 induction doses. 5 mg/kg IV given at 0, 2, and 6 weeksas an induction regimen. MAINTENANCE DOSING 5 mg/kg IV given every 6 weeks thereafteras a maintenance regimen
Etanercept: 50mg SC once weekly
Adalimumab: 40-80mg SC alt week
Golimumab: 50mg SC once a month
Certolizumab: Initial: 400 mg SC (2 injections of 200 mg), repeat at 2 and 4 weeks. Maintenance: 200 mg SC q2Weeks OR 400 mg SC q4weeks
Seku: Once weekly for 5 weeks then once monthly 150mg IV
Ixeki: 160 mg SC (ie, as two 80-mg injections) at Week 0, THEN 80 mg SC q4Weeks