The seminar covered Ankylosing Spondylitis (AS), a chronic inflammatory disease affecting the spine and sacroiliac joints. The objectives were to introduce AS, identify risk factors like gender and genetics, describe the pathophysiology involving inflammation of joints and entheses, and review clinical manifestations like back pain and stiffness. Treatment aims to reduce pain, maintain mobility, and prevent deformity using medications, exercises, bracing and surgery. Nursing care focuses on pain management, improving breathing and mobility, preventing fatigue and deformity, and providing psychological support.

1. Seminar on
Ankylosing Spondylitis
By,
Shristi shrestha
Medical surgical Nursing
M.Sc. Nursing 1st year
2016 batch

2. Learning Objective
At the end of the session the
participants will be able to
• introduce ankylosing spondylitis (AS)
• identify the incidence & risk factors of AS
• state the etiology of AS
• describe the pathophysiology of AS
• state the clinical manifestations of AS
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3. Learning Objective…
• identify the complications of AS
• describe the treatment of AS
• state the prognosis of the AS
• describe the medical management of AS
• describe the nursing management of patient
with AS
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4. Introduction
• is a chronic
inflammatory
disease primarily
affecting the spine
and sacroiliac
joints.
• Greek words
ankylos, meaning
stiffening of a joint,
and spondylo,
meaning vertebra.
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5. Introduction…
• chronic inflammation ,
progressing slowly to
bony ankylosis of the
joints of the spinal
column and
occasionally of the
major limb joints.
• results in fused
vertebrae and rigid
spine.
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6. ShristiShrestha

7. Incidence
• estimated to fall between 1 and 2 per 1000
population.
• men > women.
• usual age of onset between 15-35 years
• It is encountered in mostly young adults and
in 80% of the cases symptoms appear
before 30 years of age
• Around 0.25% population in India is
estimated to be affected by these diseases
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8. Risk Factors
• Gender (M>F)
• Age (15-35 yrs.)
• Genetic predisposition (HLA-B27)
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9. Etiology
Gene
Environmental
factors
Immune
response
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10. Pathophysiology
Both genetic & environmental
factors appear to be involved
HLAB27 presents an antigen to
the CD8+ T cells & in turn
activates the immune system
(TNF)-α & (IL-1) are thought to
play role in the inflammatory
reactions
to attack the fibrocartilage , AS
involves inflammation, cartilage
erosion
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11. Pathophysiology
enthesis, which is the site of
major histologic changes is
affected resulting in enthesitis
In addition, there is seen to be
mild and destructive synovitis
As the disease progresses it
destroys the nearby articular
tissues or joint tissues
new cartilages are replaced by bone
through fusion, Resulting in stiffness
and immobility.
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12. Common joints involved
• Axial skeletal- SI
joints, intervertebral
disc spaces,
costovertebral joints.
• Large peripheral
joints- Hips,
shoulders, knees
and
• Rarely small
peripheral joints.
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13. Clinical Manifestations…
Pain:-
Initially the patient
notices stiffness after
a period of rest ,
improving with
movement.
The pain tends to be
worst at night or in the
early morning.
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14. Clinical Manifestations…
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15. Clinical Manifestations…
• Enthesitis:
is inflammation of
the entheses, the
sites where tendons
or ligaments insert
into the bone. It is
also called
enthesopathy
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16. Complications
Anterior Uveitis
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17. Complications
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18. The research looked at 939 patients in the USA
with AS who had been admitted with a spinal
fracture.
• Cervical fractures were the most common (53%),
followed by thoracic (42%). Spinal cord injury was
present in 28% of cervical fractures and 16% of
thoracic fractures.
• More than 10% patients had fractures in more than
one region of the spine.
• 6.6% of patients died during their inpatient stay.
Spinal Fracture In Patients With
Ankylosing Spondylitis
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19. Diagnosis of AS
• Physical Assessment
Spine- there is loss of lordosis due to para-
spinal muscle spasm.
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21. • increased thoracic
kyphosis
• forward thrust of the
neck ; upright
• balance are
maintained by hips
• knees slightly flexed-
in late stage these
may become fixed
deformities.
Long standing AS
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22. Diagnosis…
Imaging tests
- Radiographic
features-
In early stage –
fuzziness of both
the sacro-iliac joints
, so that joint line no
longer clearly
defined.
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23. joints in lumber ,
thoracic , and
sometimes even the
cervical region
undergo bony
ankylosis
with prominent
anterior bridging of
the vertebral bodies.
Diagnosis…
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24. Diagnosis
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25. Modified New York criteria
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26. Medical Management
Reducing pain
and
inflammation
Maintenance
of skeletal
mobility
Preventing
deformity
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27. 1. Reducing pain &
inflammation
Pharmacological
• NSAIDs
• Anti-TNF
medication
• Corticosteroids
• DMARDs (Disease-
modifying anti-
rheumatic drugs)
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28. Recent Introduction of
Biological Drug
• In a largest clinical trial program ever
conducted in AS, involving 590
patients, By Novartis, US
• used Cosentyx® (secukinumab) an IL-
17A inhibitor that provided
improvements in the signs and
symptoms, physical function and quality
of life measures in active AS as early as
Week 1 and through to Week 52.
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29. 2. Maintenance of skeletal
mobility
Physical Therapy
• Regular exercise
program must be
started as part of
the treatment
immediately after
the patient is
diagnosed.
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30. Hydrotherapy
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31. Massage
Therapy
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32. 3. Preventing deformity
• The patient should adopt the habit of
sleeping flat upon his back on a firm
mattress , with a small pillow to
prevent increasing flexion deformity
of the spine.
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33. Maintenance of erect posture during sitting,
standing and walking is a must.
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34. Spinal Brace
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35. Heel cups
Cane or walker
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36. Surgical Management
• Joint replacement
surgery
• Total hip joint
replacement is
usually performed
for severe hip
disease.
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37. • Vertebral wedge
osteotomy in lumber
region may be
needed for the
correction of severe
kyphosis to allow the
patient see ahead
after surgery.
Before and after corrective
osteotomy in the lumber region
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38. Prognosis
• The general course of AS is benign and is
characterized by exacerbations and
remissions.
• The prime predictor of more severe
dysfunction is the presence of peripheral
joint involvement, particularly in the hips,
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39. Gender-attributable differences in
outcome of ankylosing spondylitis: long-
term results from the Outcome in
Ankylosing Spondylitis International
Study
• In this study, no gender-attributable
differences in disease activity or physical
function over time were found. However,
radiographic damage was more severe in
males. Males also had a better quality of
life over time.
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40. World AS Day is
celebrated on the first
Saturday of May each
year.
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41. In an effort to shine the light of
awareness on Ankylosing
Spondylitis.
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42. Nursing
Management

43. Nursing Assessment
1. History and physical assessment
Subjective Data:
• Low back pain, stiffness
• Fatigue
Objective data:
• Patient’s posture
• Tenderness over spine or sacroilliac region
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44. Nursing Diagnosis
1. Pain related to inflammation and stiffness in
joints.
2. Ineffective breathing pattern related to
reduced chest expansion secondary to
vertebral spine involvement.
3. Impaired physical mobility related to hip
joint inflammation and pain.
4. Self-care deficit related to reduced mobility.
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45. Nursing Diagnosis…
5. Fatigue related to pain and fever.
6. Body image disturbances related to
changes in body appearance due to loss of
spinal mobility.
7. Knowledge deficit related to prognosis of
disease condition and therapy.
8. Risk for injury related to improper gait and
balance.
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46. Nursing Interventions
1. Reducing pain and inflammation
• Apply heat packs at the affected area.
• Give anti-inflammatory analgesics as
prescribed.
• Encourage diversional activities
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47. Nursing Interventions
2. Promoting effective breathing
• Ongoing assessment of chest wall
expansion.
• instructions in deep breathing exercises,
and the avoidance of smoking and
respiratory depressants can help the client
to maintain optimal breathing.
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48. Nursing Interventions
3. Promoting mobility
• Suggest that the client perform exercise in
the shower because warm, moist heat
prompts mobility.
• Stress the importance of following the
prescribed physical therapy and exercise
program to maintain mobility
• Assist with range of motion exercises 3
times in a day.
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49. Physical Activity and Exercise:
Perspectives of Adults With
Ankylosing Spondylitis
• Exercise is key in the management of AS but
take up and compliance is low. This study
aimed to explore the attitudes of people with AS
towards physical activity.
The researchers conclude that awareness of
the benefits of physical activity appears
insufficient to motivate individuals with AS to
exercise; a number of factors influence
individual motivation to exercise.
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50. Nursing Interventions
4. Reducing Fatigue
• Ask to take rest periods alternating activity
or provide adequate rest to reduce fatigue.
• Promote daily activities and self care within
therapeutic levels.
• good pain control can significantly reduce
fatigue. Patients should be encouraged to
take analgesia and prescribed medication
effectively
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51. Nursing Interventions
5. Preventing deformity/joint
protection
• Lessen forces on the joints, both internal
(i.e. muscular compression e.g. strong grip)
and external (i.e. forces applied to joints
during activities such as carrying) forces
should be considered.
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52. Nursing Interventions
Advice on using following principles:
• Use assistive devices (such as cane/walker)
• Use the joints in their most stable positions.
• Avoid maintaining the same position for long
periods of time.
• Employ appropriate body posture & moving
and handling techniques.
• Maintain muscle strength and ROM.
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53. Nursing Interventions
6. Providing psychological support
• Encourage patient to express feelings about
changes in body image, if able to do so.
• Compliment patient on each improvement in
mobility.
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54. ANY QUERIES ??
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55. Then let’s Summarize
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56. References
• Braun J.Sieper J. Ankylosing spondylitis.
The Lancet. 2007;369(9570):1379-1390
• Casey B, O’Hanlon É, Curran M, Costello M,
McGlennon S, Pond P. Living with a Chronic
Disease – The Story of Ankylosing
Spondylitis . Available from:
https://www.physio-
pedia.com/images/a/a4/Ankylosing_Spondyli
tis.pdf
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57. References
• Wilkins, L. W. Brunner and suddarth's
textbook of medical surgical.New Delhi:
Wolters Kluwer (India) Pvt.Ltd.,
nursing.2011.11th ed., Vol. 2
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58. ShristiShrestha