Ankylosing = fusion, stiffness
Spondylitis = inflammation of spine
AS belongs to the group of Spondyloarthropathies, which are seronegative (Rheumatoid Factor -ve). There is chronic inflammation of mainly the spine and sacroiliac joints. This eventually leads to fusion and reduced movement if not adequately treated.
- Reactive arthritis
- Psoriatic arthritis
- Enteropathic spondyloarthropathy eg. IBD
UK Prevalence is estimated at 0.25-1%, with AS being more common in men. At 16 years, men:women is 6:1; at 30yrs, this ratio is 2:1.
The aetiology is currently unknown, but there is a definite genetic predisposition with >95% of AS patients being HLA-B27 +ve.
Mainly clinical diagnosis
X-Ray + MRI
- Physio + Exercise
- NSAIDs eg. Ibuprofen (gives rapid improvement in 48hrs)
- TNFalpha blockers eg. Etanercept, Adalimumab, Infliximab
- Bisphosphonates (to prevent osteoporosis)
- Surgery eg. Hip replacement
- Oxford Handbook of Clinical Medicine 8th edition.
- British Society for Rheumatology Guidelines for Prescribing TNFalpha blockers in Adults with Ankylosing Spondylitis, July 2004; Dr. Andrew Keat.
- NICE guidelines TA143: Ankylosing Spondylitis - Adalimumab, Etanercept and Infliximab: guidance, May 2008
- Physical Medicine and Rehabiliation Board Review, 2004; editor Cuccurullo S.
- Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargos R, Dougados M, Hermann K-G, Landewe R, Maksymowych W, van der Heijde D. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Disease 2009, Vol 68 supplement.
- Tam LS, Gu J, Yu D. Pathogenesis of Ankylosing Spondylitis. Nat Rev Rheumatol 2010, Vol 6 p399-405.
- Maksymowych WP. Disease Modification in Ankylosing Spondylitis. Nat Rev Rheumatol 2010 Vol 6 p75-81.
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