ankylosing spondylitis
DESCRIPTION
Presentation reviewing the epidemiology, pathophysiology and treatment for ankylosing spondylitisTRANSCRIPT
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ANKYLOSING SPONDYLITIS
TANU TUESE Musculoskeletal System
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OVERVIEW:• Epidermiology• Etiology and Risk factors• Clinical manifestations• Complications• Differential diagnosis• Diagnosis• Management
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Epidemiology• Prevalence:– 4%-5% of patient-lowback pain.– 5% to 6% in HLA-B27 postive persons.– 0.1% to 1.4% depending on the population
studied.• Demographic:– Most common between the ages of 16 – 40– 3 times more frequent in men than in women– Common in white patients– HLA-B27 positive – 5% to 6% chance of developing
ankylosing spondylitis
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Etiology• No specific cause• Risk factors:– HLA-B27 (genetic association).– Age ( adolescence or early childhood).– Sex – 2 to 3 times common in men than in women.
• Chronic inflammatory disease
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Risk Factors
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Pathophysiology
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Pathophysiology
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Clinical features• Insidious onset (over months or
years)• Episodes of low back pain and
muscle stiffness– Radiates to the buttocks or posterior
thighs.– Axial and symmetrical in distribution.– Most in the early morning and after
inactivity.– Relieved by movement.
• Physical signs:– lumbar lordosis– Pain on sacroiliac compression– restriction of chest expansion
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Extraspinal featuresRare features
• Anterior uveitis (25%) and conjunctivitis(20%)
• Prostatitis(80% men)- usually asymptomatic
• Cardiovascular disease– Aortic incompetence– Mitral incompetence– Cardiac conduction
defects– Pericarditis
• Amyloidosis• Atypical upper lobe
pulmonary fibrosis
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Differential diagnosis• Other spondyloarthropathies. – Enteropathic arthritis– Psoraitic arthritis– Reactive arthritis
• Degenerative disk disease• Diffuse idiopathic skeletal hyperostosis syndrome• Sarcoidosis• Infectious sacroiliitis
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Complications• Neurological complication• Kidneys- Amyloidosis• Heart complication• Lung problems
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Investigations• Physical Examination
– Schobers test– Chest expansion– Cervical mobility
• Laboratory findings:– ESR and CRP : usually raised.– Serum rheumatoid factor (RF) is negative.– Renal function test– FBC
• Imaging:– Spine X-rays- lateral thoracolumbar view– MRI and CT scan
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Physical examination• Vital signs and check for fever and
signs of weight loss• Examine the skin and nails and
check for psoraisis• Examine the eyes for signs of
inflammation• Auscultate the chest • Examine the spine
– Schober test– Faber test– Range of movement
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Imaging
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Diagnosing • Clinical criteria:
– Low back pain with inflammatory characteristics– Limitation of lumbar spine motion in the sagittal and frontal planes– Decrease chest expansion
• Radiographic criteria:– Bilateral sacroiliitis of grade 2 or higher– Unilateral sacroiliitis of grade 3 or higher
• Radiologic criteria (grade 1 = suspicious change of the sacroiliac joints; grade 2 = minimal change consistent with sacroiliitis; grade 3 = unequivocal change in the sacroiliac joints; grade 4 = severe sacroiliitis with marked ankylosis).
• Need one clinical and one radiographic criterion
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Management • Primary management
– NSAIDs (naproxen and indomethacin)– Muscle relaxants– DMARDs– Exercise therapy– Tobacco discontinuation
• Surgical therapy– Indication :
• sagittal plane deformity• Severe back pain• Upper cervical instability
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Management(spine)• Opening wedge surgery
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Management(spine)• Closing wedge surgery
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Management(spine)A. PREOPERATIVEB. POSTOPERATIVE
CERVICOTHORACIC KYPHOSIS
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Management(spine)
THORACOLUMBAR KYPHOSIS
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Reference• Goldman’s Cecil Medicine, 24th edition• Rothman –Simeone The spine, 6th edition• Nelson textbook of Pediatrics,19th edition• Davison’s Priniciples and Practice of Medicine,21st edition
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001457/• http://www.mayoclinic.com/health/ankylosing-spondylitis/DS00483• http://www.medicinenet.com/ankylosing_spondylitis/article.htm• http://www.spondylitis.org/about/complications.aspx#