Ankylosing spondylitis

Chronic systemic inflammatory disorder affecting primarily the axial skeleton.

0.5% of population.

Early lesions of ankylosing spondylitis show subchondral granulation tissue that can erode the joint.

The granulation tissue will be replaced by fibrocartilage and then by ossification.

Pathologic changes occur in the ligaments and capsular attachments to bones and is ref2242ed to as enthesitis.

Initially the process starts at the junction of the vertebra and the annulus fibrosus of the intervertebral disc of the spine and the outer fibers of the disc become ossified and form a syndemophyte.

The spinal disc ossification leads to the bamboo spine appearance, characteristic of ankylosing spondylitis.

Ankylosing spondylitis inflammatory response involves CD4+ and CD8+ T lymphocytes and cytokines TNF-alpha and transforming growth factor-beta (TGF-B).

Involvement outside the joints include iritis, aortic fibrosis, aortitis, pulmonary fibrosis and neurologic abnormalities.

Extra spinal joints involved are usually large joints of the legs, such as the knees.

Acute iritis occurs in up to 25-30% of patients and his unilateral in most cases.

Cardiac involvement can lead to heart block.

Heart block is a rare complication and is caused by the effects of obliterated endoarteritis and fibrosis on the small arteries that feed the cardiac conduction system.

With inflammation to costovertebral and costotransverse joints the chest wall range of motion can occur.

AS is a disorder that causes chronic pain in the joints, usually starting in the back and buttocks.

AS has no clear trigger.

If there is a history of AS in a person’s family, they are more likely to have the disease themselves,

Symptoms of AS, such as back pain and pain in the buttocks, will show up with no known cause.

Some patients will not experience back pain at first but may experience a tight ribcage that makes it hard to breathe, or have stiff joints or pain in their ankles, or may even experience inflammation in their wrists.

Pain gradually gets worse, often over the course of a few months or more.

Stiffness can gradually grow into aching, stiff joints, and a rigid-feeling spine as the disorder progresses.

While in many conditions, chronic back pain gets better when resting, the opposite is true with AS.

People who have AS will experience more pain when resting or sleeping, and pain gradually gets better as they move around throughout the day.

The pain caused by AS gets better with exercise.

Some patients with AS will feel relief after stretching or doing other forms of exercise.

Other symptoms associated with AS, include: inflammation of the eye, gastrointestinal disorders, and fatigue.

There is one specific blood test associated with AS is the HLA-B27 gene test, however, and there are many people with the gene who never develop AS.

Imaging will usually confirm the presence of AS.

Appears to be more common in men.

Most cases of AS occur between the teenage years and the age of 30.

Pregnant women who have AS may have difficulty giving birth, as inflammation in the spine and hips can make an epidural shot problematic.

Treatment will focus on slowing the progression and reducing the symptoms, and will typically include using NSAIDs to control pain and inflammation, and drugs known as TNF-a inhibitors to slow the progression of the disorder.

Exercise and flexibility can play a major role in reducing symptoms, and physical therapy, exercise, and techniques to correct posture are required.

Breathing exercises can help to expand the chest, and patients are encouraged to employ low-impact, full body workouts, such as swimming and cycling.

The process occurs in both men and women of all ages.

First symptoms usually show up before the age of 30, and rarely occur after the age of 45.

The disorder can affect ability to function in daily lives, disrupt ability to work, and can significantly reduce quality of life.

AS progresses differently in each individual, as some experience mild symptoms all of their lives that progress slowly while other progress quickly.

Some cases lead to ankylosis, when two or more bones in the spine fuse together or the sacroiliac joint becomes fused.

Pulmonary fibrosis that occurs is usually asymptomatic.

Associated with nephrolithiasis.

Neurologic changes may be related to spinal fractures or spinal stenosis, and may cause the cauda equina syndrome.

Spinal fractures in ankylosing spondylitis occur most commonly in the cervical spine.

Ankylosing spondylitis affects 0.1-0.2% of the population, and 0.1-1% of the world population.

Pain and stiffness are daily symptoms an occur in more than 70% of patients.

Ankylosing spondylitis is associated with fatigue in approximately 65% of patients.

A chronic multisystem inflammatory process of the sacroiliac joints and the axial skeleton.

A seronegative spondyloarthropathy.

Associated often with other seronegative spondoarthropathies which includes psoriasis, juvenile chronic arthritis, ulcerative colitis, and Crohn’s disease.

A strong genetic predisposition and association between B27 HLA.

90% of patients positive for HLA-B27.

B27 may resemble or act as a receptor for an antigen that can initiate the inflammatory process.

Prevalence 0.1-.2% in the general population.

Prevalence 1-2% among individuals with the HLA B27 antigen.

10% of patients with AS negative for HLA-B27.

10-20% of patients with HLA-B27 and a first degree relative with ankylosing spondylitis develop ankylosing spondylitis.

Family history of ankylosing sondylitis common as is a history of another seronegative spondylopathy.

Involvement of thesacroiliac joints required for diagnosis.

Most commonly affected joints are the sacroiliac joints and the axial skeleton.

Entire spine can undergo fusion over time, as it typically begins in the lower spine and proceeds

X-Ray findings intervertebral syndesmophytes, disk ossification, ankylosis between joint articulations and bridging.

Hallmark radiographic detection of sacroiliitis or syndesmophytes onlumbosacral spine radiographs, but MRI detection of sacroiliitis may also aid in diagnosis.

New bone formed in AS is brittle , becomes osteoporotic with high risk of spinal fractures.

Risk of fracture in AS is related to bone resorption and erosion and also to new bone formation at a entheses at joint margins and to the formation of syndesmophytes.

Less common involved joints are the shoulders and the hips, and the least involvement with peripheral joints.

Treatment targets the inflammatory pathways that mediate symptoms of joint stiffness and bone erosions and also the pathway that leads to mechanical weakness of existing bone.

Cytokine inhibitors such as inhibitors of tumor necrosis factor provide symptomatic improvement, even in patients with advanced joint fusion.

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