Ankylosing spondylitis

Question mark posture

Protrudent abd

Loss of lumber lordosis

Restriction of the spinal movement in all directions

Heel-occipit-hip test is positive

Schober’s test is positive

Ask about Hx of:

Back pain which increase with rest or prolong immobility, and improve with exercise

Asymmetrical arthropathy

Heel pain (achellis tendonitis, planter faciitis)

Examine for:

Reduce Chest expansion and apical fibrosis

Eyes for iritis

Heart for AR

What are the clinical features?

Apical fibrosis

Anterior uvitis

Aortitis

Aortic regurg

Amyloidosis

Achellis tendonitis

What are the criteria for diagnosis?

Clinical: limited movement of the spine in the 3 planes

Pain in the lumber spine

Chest expansion <2.5

Radiological: uni/bilateral sacroilitis

What are the Ix?

ESR/CRP

X-ray of the spine: loss of lumber lordosis

Squiring of the vertebra

Bamboo spine (calcification of ligaments,

Fusion of the spinal facets,

Syndesmophytes)

X-ray sacroiliac joint

What are the lines of management?

Exercise

NSAID’s

Spinal surgery (vertebral wedge oesteotomy)

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