Ankylosing spondylitis
From Ganfyd
Contents |
Introduction
A chronic inflammatory rheumatic disease mainly affecting the axial skeleton, usually starting in the sacro-iliac joints, but often progressing to involve the spine.
Aetiology
Commonly starts in the 20s, male to female ration 2:1 to 3:1. HLA-B27 predisposes. Other risk factors include psoriasis, inflammatory bowel disease, reactive arthritis.
Clinical
Clinical history of inflammatory back pain and early morning stiffness.
Signs
Early on there is limitation of spinal movement and chest expansion. As the disease progresses there is restriction of lateral and forward flexion, and extension. The lumbar lordosis is often lost, or is fixed even on forward flexion. Later a thoracic kyphosis develops, restricting thoracic rotation and chest expansion.
Symptoms
Lower back pain, affecting the lumbar spine and buttocks. As the disease progresses there is stiffness and reduced range of movement. In severe cases movement of the cervical spine is also restricted.
It can also be associated with acute peripheral arthritis, usually oligoarticular and assymetrical, and with a joint effusion as the first sign. Enthesitis e.g. at the insertion of the Achilles tendon and the plantar fascia, also occur.
