Ankylosing spondylitis
CC: back pain or diarrhea
Diagnosis:
Ankylosing spondylitis
Area to examine ?
Check posture
Fixed kyphoscoliosis
Loss of lumbar lordosis with extension of cervical spine
Reduced chest expansion ( < 5 cm increase in. Girth )
Increased occiput-wall distance ( > 5 cm )
Reduced range of movement throughout entire spine
Do Shöber test: positive is expansion by less than 5 cm on maximum forward flexion
Complication ?
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Atrio-ventricular nodal heart block
Arthritis ( may be psoriatic arthropathy )
Amyloidosis
Tell me why he/she got diarrhea ?
This is extra articular manifestation ( inflammation of GI tract +/- immune related )
What will you do ?
X-ray sacroiliac joints
• If equivocal or absent findings, Do MRI
Blood HLA B27
Physiotherapy like swimming
Address concern like work, driving , ADL, …
NSAID like ibuprofen and naproxen ( no aspirin )
Sulfasalazine for peripheral joint disease
For axial disease:
• NSAID
• Anti-TNF like etanercept
• IL-17 inhibitors
Janus kinase inhibitors tofacitinib
Extra :
• AS is a type of seronegative spondyloarthropathy, meaning that tests show no presence of
rheumatoid factor (RF) antibodies.
