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Ankylosing Spondylitis: Dr. Amit Dhawan

This document discusses Ankylosing Spondylitis, a chronic inflammatory disease. Key findings include fusion of the sacroiliac joints and spine seen on imaging. MRI can detect early changes while radiographs are important for diagnosis. Differential diagnoses include other forms of arthritis. Features are predominantly axial skeleton involvement, association with HLA-B27, and initial sacroiliac joint involvement progressing to fusion. Treatment focuses on exercises and posture to prevent kyphosis.

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Richa Sood
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43 views15 pages

Ankylosing Spondylitis: Dr. Amit Dhawan

This document discusses Ankylosing Spondylitis, a chronic inflammatory disease. Key findings include fusion of the sacroiliac joints and spine seen on imaging. MRI can detect early changes while radiographs are important for diagnosis. Differential diagnoses include other forms of arthritis. Features are predominantly axial skeleton involvement, association with HLA-B27, and initial sacroiliac joint involvement progressing to fusion. Treatment focuses on exercises and posture to prevent kyphosis.

Uploaded by

Richa Sood
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Ankylosing Spondylitis

Dr. Amit Dhawan


Radiographic Findings
• Ankylosis of sacroiliac joints
• Syndesmophytes in the lumbar spine
• Fusion of the interspinous ligament
• Arthropathy of both hips
• Enthesopathy of ischial tuberosity
Imaging Modalities
• Radiographs are the most important for
detection, diagnosis, and follow-up
– limited in early sacroiliac changes
• CT useful in equivocal sacroiliac
involvement
• MRI able to assess early cartilage
abnormalities and bone marrow edema
Differential Diagnosis
• Ankylosing spondylitis
• Diffuse idiopathic skeletal hyperostosis
• Gout
• Psoriatic arthritis
• Rieter syndrome
• Rheumatoid arthritis
• Spondylodiskitis
Ankylosing Spondylitis Features
• Chronic & progressive form of seronegative
arthritis with axial skeleton predominance
• Affects 0.1-0.2% of the population
• 90-95% of patients are HLA-B27 positive
– 7% of general population is positive, only 1%
of positives will develop ankylosing spondylitis
• Male:female 4-10:1
Features cont.
• Age of onset 15-35 years old
– juvenile onset associated with more frequent &
severe hip & peripheral joint involvement
• Life expectancy unaffected, although 20%
morbidity
– most patients able to maintain a normal lifestyle
Features cont.
• Starts with sacroiliac joints
– begins with sclerosis, eventually get ankylosis
• Progresses to include facet joints, spine,
iliac crest, ischial tuberosity, greater
trochanter, hips, patella, calcaneus,
glenohumeral joints
– peripheral joint involvement in 30%
Features cont.
• Enthesopathy - calcification & ossification
of ligaments, tendons, joint capsules at
insertion into bone
• Erosion of subligamentous bone due to
inflammatory response
• Fusion of interspinous ligament
– Dagger sign
Features cont.
• Syndesmophytes - bony bridges between
vertebrae & ossification of joint capsule
– Bamboo spine
• Resorption of vertebral endplates
• Soft tissue findings are new bone formation
in outer layers of annulus fibrosis as well as
chronic synovitis and capsular fibrosis
Physical Findings
• Patients usually present with low back pain
and stiffness, which improves with activity
• Decreased range of motion in lumbar spine
• Thoraco-cervical kyphosis (late)
• One-third of patients will have acute,
unilateral uveitis
Other Complications
• Pseudoarthrosis (Anderson lesion), cervical
spine fracture, C1-C2 subluxation, cauda
equina syndrome
• Peripheral joint ankylosis
• Restrictive lung disease, upper lobe fibrosis
• Aortic root dilation (20%) & murmur (2%)
Treatment
• Posture training & range of motion
exercises to prevent kyphosis
• Sleep prone or supine in firm bed, no pillow
• Breathing exercises
• NSAIDs for symptomatic relief

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