4- ANKYLOSING SPONDYLITIS

• Ankylosing spondylitis


  Inflammatory disorder of the spine & sacroiliac joints, mainly in young adults
• Ankylosing spondylitis


  • 5 times more common & severe in men
• Symptoms & Signs


  • Increasing pain & prolonged morning stiffness in lower back & buttocks that improves with exercise and is worse with rest
  • Progressive loss of spinal movement (lumbar) in sagittal & frontal planes due to fusion of lumbar vertebra à abnormal Schober test (N>15cm), loss of lumbar lordosis, increased thoracic kyphosis
  • Compensatory neck hyperextension, fixed flexion of hips, & flexion of knees
  • Enthesitis à Achilles tendonitis & plantar fasciitis (enthesitis)
  • Costovertebral joint involvement à reduced chest expansion
• Non-articular manifestations


  • Anterior uveitis
  • Aortic incompetence (regurgitation)
  • Apical lung fibrosis
  • Cardiac conduction defect
• Investigations

  • High ESR and CRP
  • X-ray findings:
  • Erosions and sclerosis of sacroiliac joints (sacroiliitis)
  • Calcification of interspinous ligaments and formation and fusion of bony spurs (syndesmophytes) à bamboo spine
  • MRI detects the disease earlier but is usually not needed
• Treatment


  1. Morning exercises

  2. Slow release NSAIDs at night

  3. Anti TNF a (infliximab)

  4. PDE4 inhibitor (studies)

  5. Methotrexate is only effective with peripheral arthritis. It's not useful in axial disease.