Ankylosing Spondylitis

Posted by e-Medical PPT
Prevalence of Ankylosing Spondylitis
The estimated prevalence is 0.2% to 1.2%
Among adults with chronic low back pain:  prevalence is about 5%

Ankylosing spondylitis
Greek:  “ankylos” = bent
                 “spondylos” = spinal vertebra
Chronic inflammatory disease of axial skeleton causing back pain and progressive stiffness
Peak age 20-30 years
Three times more prevalent in men

Ankylosing spondylitis (AS) belongs to group of disorders that share a predilection to cause inflammation at  enthesis and an association with HLA-B27
Other members of spondyloarthritis (SpA) family:  reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease

Pathogenesis
Strong link between AS and HLA-B27
Relative Risk if 1st degree relative with AS:  16 to 94
Twin studies concordance of AS:  63% for identical twins
90% of risk estimated to be genetic
Only small percentage of HLA-B27 individuals in population suffer from a SpA (3-8% of Americans HLA-B27 positive), suggesting that other genetic and environmental factors may  play a role

History - Inflammatory back pain
Inflammatory back pain
Onset before age 40 years
Insidious onset
Improvement with exercise
No improvement with rest
Pain at night (with improvement upon arising)
Patient has a 25% probability of having ankylosing spondylitis if four of five of the above symptoms are present, assuming a 5% prevalence of AS among patients with chronic low back pain.

Exam
Schober test
Lateral spine flexion test
Chest expansion test

Schober’s test
Make a mark between two posterior superior iliac spines
Make another mark 10 cm above first mark
Have patient bend at waist
Distance between two marks normally if greater than 15 cm...

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