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Ankylosing spondylitis-
Chronic Inflammatory spondyloarthropathy with progressive
symptoms of pain and stiffness resulting in severe incapacitating
spinal deformity along with
systemic Involvement(eyes,lungs,heart,)
Incidence of Ankylosing spondylitis-
predominantly males (unlike RA)
young 13-30 y/o
common in European ancestory
Native Indians
Although any ethnicity can be involved.
Etiology of Ankylosing spondylitis-
Cause is still Unknown.
genetic predisposition -Familial
HLA B27 (90%)
AutoImmune ?
Pathogenesis of Ankylosing spondylitis-
Hallmark- chronic Inflammation of
spine,sternum,sacrum and other large
joints leading to pain and stiffness of
the back.
Central joints of the body is affected.
Synovitis of the SI joint and the
vertebral facet joints
Enthesopathy of the spine and pelvis ligaments
Destruction of articular cartilage
Inflammation of the fibrous capsule
Ossification of the vertebral joints
through formation of syndesmophites-
that begin in D_Lx region--
bony union - ankylosis
Intervertebral discs, symphisis pubis and manubrio-sternal joints
may be involved.
calcification of ligaments
Pathogenesis of AS-
3 stages involved.
Inflammation- fibrosis- ossification (bony union -ankylosis)
Signs and symptoms of AS-
Early- mild intermittent pain and stiffness in the back with some limitations of ROM
Later-Flattening of the Lumbar Lordosis
Flattening of the cervical lordosis and
kyphosis of the dorsal spine
resulting a rounded "C" shaped
spine.
Spinal movements are completely limited.
Reduced chest expansion-asymmetrical
decreased Lung capacities
Other organs involved in AS-
Eyes - Irido-cyclitis
Uveitis(tearing,pain L/o vision)
lungs- pulmonary fibrosis
heart- conduction defects
Ao Insufficiency/Regurgitation
Complications of AS-
Neurological- Cauda Equina syndrome
cord compression
Amyloidosis-
Achilles tendinitis
Gibbus -angulation of spine
decreased VC,TLC
Increased RV, FRV
Asymmetrical polyarthritis
pain Improves with activity
pain worsens with Inactivity ,Rest
Pain is worse at Night.
Chest pain (aortitis,, Pulmonary Infection)
Pain is initially intermittent
later continuous.
May mimic symptoms of Lumbago
Sciatica, Trochantic Bursitis
OA of the Hip , spine