Ankylosing Spondylitis
The spine becomes just like a solid rod of bone between your skull, neck and pelvis hence named as POKER'S BACK. Over 90% of patients possess HLA-B27 (Human Leucocyte Antigen).
Ankylosing Spondylitis (AS) is a sero negative, progressive chronic inflammatory disease. Over 90% of patients are HLA-B27 positive.
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It comes down to back pain and a general sense of ill health which eventually results in stiffening and inability to bend the spine. AS leads to bony ankylosis beginning with ossification of ligaments and tendons from the spine, particularly at junctions with bones. ossification usually starts in the dorso lumbar region or sacro iliac joint. Round the joint there is lack of cortex and erosions with consequent widening of joint space. Later within the disease process, there's sclerosis and finally ankylosis.
The exact reason for Ankylosing Spondylitis (AS) is unknown but there's two factors which are regarded as the cause of this condition.
• Genetic Factors.
• Environmental factors.
Epidemiology
Prevalence varies in various races, in white population it's between 1-10 patients per 1000 persons. Age onset is commonly in 18-30 but could start at all ages.
males are more commonly affected than females, usually ratio is 3:1. The very first degree relatives from the patient of AS convey more chances to develop this problem.
Pathology
The pathology of AS range from the following process-
Synovitis Initially, the soreness of the synovium occur, which can be identical histologically to that in rheumatoid arthritis symptoms(RA). Mostly commonly the synovitis starts, firstly in the sacroiliac joints followed by another region of the spine.
Enthesopathy This term describes an inflammatory reaction at the enthesiswhich may be the zone of ligamentous attachment towards the bone, and this may be the characteristic feature of AS occurring commonly in the spine and close to the pelvis.
Capsular Inflammation
Cartilage Destruction and Bony Erosion This occur because of synovitis and the inflammation from the ligament and the capsules. The cartilage from the joint gets destroyed, and becomes rough and also the bony erosion occurs.
Ossification All of the above factors result in the formation of new bones at these areas, and bridging happens between the vertebral bodies, usually in the edge of one body to that particular of the next, across the outer layer of the disc. This typical phenomenon is called the marginal syndesmophyte formation. Ossification can also happen in the anterior and posterior longitudinal ligament and in other ligaments from the spine.
Ankylosis All the features of the aforementioned and most important the ossification part, results into fusion of all of the vertebrae of the spine, which condition is called bamboo spine. The development of the syndesmophytes starts usually in the dorso-lumbar region. After bony fusion the pain sensation may subside, leaving the spine permanently stiff.
Ankylosing Spondylitis Symptoms
The seriousness of symptoms can vary from mild to severely.
Common symptoms can include:
• Stiffening and pain (arthritis) from the:
Lower back
Sacroiliac joint,
possibly radiating on the legs
• Pain that is often worse during the night
• Stiffness that is worse each morning
• Symptom improvement with exercise or activity
• Occasionally, pain and stiffness in other joints:
Knee
Shoulders
Rib cage
Neck
Shoulders
Feet
• Chest pain, which might suggest heart, heart valve (aortic insufficiency), or lung involvement
• Eye pain, visual changes, increased tearing which might suggest eye involvement (uveitis)
Less frequent symptoms may include:
• Fatigue
• Loss of appetite or weight reduction
• Fever
• Numbness (if arthritic spurs compress the spinal nerves)
Associated Conditions
• Iritis.
• Aortic regurgitation- Cardiovascular disease conduction defects.
• Apical pulmonary fibrosis.
• Inflammatory bowel disease.
• Myelopathy secondary to atlanto-axial subluxation.
Complications of Ankylosing Spondylitis
• Neurological involvement/cauda equina syndrome.
• Spinal fracture.
• Spinal cord compression.
• Amyloidosis.
• Painful heel or achilles tendinitis.
• Romanus lesions.
• Reduced chest expansion and vital capacity.
• Possibility of chest infection.
Ankylosing Spondylitis Diagnosis and Investigation
Early diagnosis is essential in order to start on the Ankylosing Spondylitis treatment plan. Making an accurate diagnosis for ankylosing spondylitis can be challenging, however, due to the fact the symptoms of ankylosing spondylitis are so much like other, more common back problems and also the symptoms and signs occur slowly during a period of years.
Erythrocyte Sedimentation Rate The sedimentation minute rates are generally raised compared to the inflammatory activity within 70% of patients.
HLA-B27 test This really is positive in about 95% of patients.
Haemoglobin Normochromic or normocytic anaemia may occur however in contrast to RA, patients with active disease usually have a normal haemoglobin and blood film.
Synovial Fluid Includes a moderate number of mononuclear leucocytes as opposed to the increased polymorphonuclear leucocyte count of RA fluid.
Rheumatoid Factor Rheumatoid factors are absent.
Pulmonary Function Tests In patients with thoracic involvement usually show diminished vital and total lung capacity, increased residual volume and functional residual volume. Flow measurements are often normal.
Nuclear scans Technitium stannous pyrophosphate bone scans, can frequently detect areas of active inflammation in AS, before standard changes can be found.
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Radiological Study
The features of various sites are:
a)Sacro-iliac joint:
• Sclerosis from the ilium and sacrum on each side of the joint.
• Hazziness from the joint margins which afterwards show erosions.
• Narrowing of joint space which might progress to fusion.
• When ankylosis is done, the periarticular sclerosis fades. Sometimes leaving evidence of the previous joint line, known asGhost joint.
b)Spine: Spinal changes include
• Squarring from the vertebral bodies i.e lack of normal anterior concavity on the lateral view.
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• Syndesmophyte formation usually first seen in the thoraco-lumbar level.
• Arthritic changes and then apophysial joint fusion occurs that is best seen in cervical spine.
• Atlanto-axial subluxation.
• Calcification from the paraspinal ligaments.
• The romanus sign, may be the erosion surrounded by sclerosis in the vertebral body margin.
Ahead of time Disease
• The characteristic bamboo spine is a result of syndesmophyte or paraspinal ligament calcification round the normal disc space.
• Spondylodiscitis may develop within the lower thoracic and upper lumbar segments. Erosive alterations in the anterior vertebral bodies next to the disc, which become progressively destroyed and results in angulation of the spine. The look may resemble infection or trauma but is most likely part of the spondylitic process.
Ankylosing Spondylitis (AS) is a sero negative, progressive chronic inflammatory disease. Over 90% of patients are HLA-B27 positive.
It comes down to back pain and a general sense of ill health which eventually results in stiffening and inability to bend the spine. AS leads to bony ankylosis beginning with ossification of ligaments and tendons from the spine, particularly at junctions with bones. ossification usually starts in the dorso lumbar region or sacro iliac joint. Round the joint there is lack of cortex and erosions with consequent widening of joint space. Later within the disease process, there's sclerosis and finally ankylosis.The exact reason for Ankylosing Spondylitis (AS) is unknown but there's two factors which are regarded as the cause of this condition.
• Genetic Factors.
• Environmental factors.
Epidemiology
Prevalence varies in various races, in white population it's between 1-10 patients per 1000 persons. Age onset is commonly in 18-30 but could start at all ages.
males are more commonly affected than females, usually ratio is 3:1. The very first degree relatives from the patient of AS convey more chances to develop this problem.
Pathology
The pathology of AS range from the following process-
Synovitis Initially, the soreness of the synovium occur, which can be identical histologically to that in rheumatoid arthritis symptoms(RA). Mostly commonly the synovitis starts, firstly in the sacroiliac joints followed by another region of the spine.
Enthesopathy This term describes an inflammatory reaction at the enthesiswhich may be the zone of ligamentous attachment towards the bone, and this may be the characteristic feature of AS occurring commonly in the spine and close to the pelvis.
Capsular Inflammation
Cartilage Destruction and Bony Erosion This occur because of synovitis and the inflammation from the ligament and the capsules. The cartilage from the joint gets destroyed, and becomes rough and also the bony erosion occurs.
Ossification All of the above factors result in the formation of new bones at these areas, and bridging happens between the vertebral bodies, usually in the edge of one body to that particular of the next, across the outer layer of the disc. This typical phenomenon is called the marginal syndesmophyte formation. Ossification can also happen in the anterior and posterior longitudinal ligament and in other ligaments from the spine.
Ankylosis All the features of the aforementioned and most important the ossification part, results into fusion of all of the vertebrae of the spine, which condition is called bamboo spine. The development of the syndesmophytes starts usually in the dorso-lumbar region. After bony fusion the pain sensation may subside, leaving the spine permanently stiff.
Ankylosing Spondylitis Symptoms
The seriousness of symptoms can vary from mild to severely.
Common symptoms can include:
• Stiffening and pain (arthritis) from the:
Lower back
Sacroiliac joint,
possibly radiating on the legs
• Pain that is often worse during the night
• Stiffness that is worse each morning
• Symptom improvement with exercise or activity
• Occasionally, pain and stiffness in other joints:
Knee
Shoulders
Rib cage
Neck
Shoulders
Feet
• Chest pain, which might suggest heart, heart valve (aortic insufficiency), or lung involvement
• Eye pain, visual changes, increased tearing which might suggest eye involvement (uveitis)
Less frequent symptoms may include:
• Fatigue
• Loss of appetite or weight reduction
• Fever
• Numbness (if arthritic spurs compress the spinal nerves)
Associated Conditions
• Iritis.
• Aortic regurgitation- Cardiovascular disease conduction defects.
• Apical pulmonary fibrosis.
• Inflammatory bowel disease.
• Myelopathy secondary to atlanto-axial subluxation.
Complications of Ankylosing Spondylitis
• Neurological involvement/cauda equina syndrome.
• Spinal fracture.
• Spinal cord compression.
• Amyloidosis.
• Painful heel or achilles tendinitis.
• Romanus lesions.
• Reduced chest expansion and vital capacity.
• Possibility of chest infection.
Ankylosing Spondylitis Diagnosis and Investigation
Early diagnosis is essential in order to start on the Ankylosing Spondylitis treatment plan. Making an accurate diagnosis for ankylosing spondylitis can be challenging, however, due to the fact the symptoms of ankylosing spondylitis are so much like other, more common back problems and also the symptoms and signs occur slowly during a period of years.
Erythrocyte Sedimentation Rate The sedimentation minute rates are generally raised compared to the inflammatory activity within 70% of patients.
HLA-B27 test This really is positive in about 95% of patients.
Haemoglobin Normochromic or normocytic anaemia may occur however in contrast to RA, patients with active disease usually have a normal haemoglobin and blood film.
Synovial Fluid Includes a moderate number of mononuclear leucocytes as opposed to the increased polymorphonuclear leucocyte count of RA fluid.
Rheumatoid Factor Rheumatoid factors are absent.
Pulmonary Function Tests In patients with thoracic involvement usually show diminished vital and total lung capacity, increased residual volume and functional residual volume. Flow measurements are often normal.
Nuclear scans Technitium stannous pyrophosphate bone scans, can frequently detect areas of active inflammation in AS, before standard changes can be found.
The features of various sites are:
a)Sacro-iliac joint:
• Sclerosis from the ilium and sacrum on each side of the joint.
• Hazziness from the joint margins which afterwards show erosions.
• Narrowing of joint space which might progress to fusion.
• When ankylosis is done, the periarticular sclerosis fades. Sometimes leaving evidence of the previous joint line, known asGhost joint.
b)Spine: Spinal changes include
• Squarring from the vertebral bodies i.e lack of normal anterior concavity on the lateral view.
• Syndesmophyte formation usually first seen in the thoraco-lumbar level.• Arthritic changes and then apophysial joint fusion occurs that is best seen in cervical spine.
• Atlanto-axial subluxation.
• Calcification from the paraspinal ligaments.
• The romanus sign, may be the erosion surrounded by sclerosis in the vertebral body margin.
Ahead of time Disease
• The characteristic bamboo spine is a result of syndesmophyte or paraspinal ligament calcification round the normal disc space.
• Spondylodiscitis may develop within the lower thoracic and upper lumbar segments. Erosive alterations in the anterior vertebral bodies next to the disc, which become progressively destroyed and results in angulation of the spine. The look may resemble infection or trauma but is most likely part of the spondylitic process.
.jpg)
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