ANKYLOSING SPONDYLITIS

This is a chronic inflammatory arthritis especially affecting sacroiliac joints and spine and characterized by progressive stiffening and fusion of the axial skeleton.

INCIDENCE

• Age: 20-30 years.

• Sex: Male & female ratio 4: 1

• More than 90% of affected persons carry the histocompatibility antigen HLA-B-27.

CLINICAL FEATURES

Symptoms

• Onset: Insidious, occasionally acute resembling lumbar disc protrusion.

• Back pain: Recurring episodes of low back pain and stiffness sometimes radiating to the buttocks or thighs. Pan is worse in the early morning and after inactivity.

• Chest Pain: Chest pain aggravated by breathing results from the involvement of the costovertebral joints.

• Heel Pain: due to plantar fasciitis.

Signs

• Failure to obliterate the lumbar lordosis on forward flexion.

• Pain on sacroiliac compression

• Tenderness over a bony prominence such as iliac crest, ischial tuberosity and greater trochanter.

• Restriction of movements of lumbar spines in all directions.

• As the disease progresses, stiffness increases throughout the spine.

• Iritis occurs in 25% of patients.

• Aortic regurgitation

Anterior uveitis.

INVESTIGATIONS

• ESR – often raised

• RA factor absent.

• HLA B-27 in 90% cases, (present in 8% of normal population).

X-ray lumbar sine

• The sacroiliac joints are eroded with irregular margins and sclerosis of adjacent bone. As the disease advances, the sacroiliac joints may fuse.

• Syndesmophyte: It is a characteristic

abnormality in the spinal column, characterized by calcification and ossification of the interspinous ligaments, appearing as continuous lines. Therefore called “ tramline appearance”.

• Vertebrae appear square as a result of erosion of their comers.

MRI Lumbosacral spine

MANAGEMENT

Non-steroidal anti-inflammatory drugs NSAIDs.

These drugs are very effective in relieving night pain and morning stiffness.

Regular exercise to prevent deformities.

• Sulhasalazine for long-term suppression in the involvement of peripheral arthritis

• Steroids: local steroid injection can be helpful for plantar fasciitis.

Refer to rheumatologist