The Diagnosis and Management of Ankylosing Spondylitis

Posted by e-Medical PPT Friday, February 25, 2011
Natural History of Ankylosing Spondylitis
Highly variable
Early stages: spontaneous remissions and exacerbations
Spectrum of severity
Mild with limited sacroiliac or lumbar joint involvement to severe, debilitating disease
“Pre-spondylitic” phase – unrecognized period of progressive structural damage over a 5-to-10-year period

Pathogenesis of AS
Incompletely understood, but knowledge increasing
Interaction between HLA-B27 and T-cell response
Increased concentration of T-cells, macrophages, and proinflammatory cytokines
Role of TNF
Inflammatory reactions produce hallmarks of disease

Clinical Features of AS
Skeletal
Axial arthritis (eg, sacroiliitis and spondylitis)
Arthritis of ‘girdle joints’ (hips and shoulders)
Peripheral arthritis uncommon
Others: enthesitis, osteoporosis, vertebral, fractures, spondylodiscitis, pseudoarthrosis

Extraskeletal
Acute anterior uveitis
Cardiovascular involvement
Pulmonary involvement
Cauda equina syndrome
Enteric mucosal lesions
Amyloidosis, miscellaneous

Clinical Criteria
Low back pain, > 3 months, improved by exercise, not relieved by rest
Limitation of lumbar spine motion, sagittal and frontal planes
Limitation of chest expansion relative to normal values for age and sex

Radiologic Criteria
Sacroiliitis grade
2 bilaterally or grade 3 – 4 unilaterally

Grading
Definite AS if radiologic criterion present plus at least one clinical criteria
Probable AS if:
Three clinical criterion
Radiologic criterion present, but no signs or symptoms satisfy clinical criteria

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