ankylosing%20spondylitis
ANKYLOSING SPONDYLITIS
Treatment Guideline Chart
Spondyloarthritis refers to a group of inflammatory diseases characterized by spinal & joint oligoarthritis, enthesitis, and sometimes mucocutaneous, ocular and/or cardiac manifestations.
Ankylosing spondylitis is a prototype of spondyloarthritis, particularly of the axial form.
Diagnosis of ankylosing spondylitis is definite if any of the radiological criterion (grade≥2 bilateral sacroiliitis or grade ≥3 unilateral sacroiliitis) is associated with at least one of the clinical criterion (low back pain & stiffness for >3 months that improves with exercise but not relieved by rest, limitation of motion of the lumbar spine in the sagittal and frontal planes, limitation of chest expansion relative to normal values correlated for age and gender.

Ankylosing%20spondylitis Signs and Symptoms

Introduction

  • Axial spondyloarthritis refers to a group of inflammatory diseases characterized by spinal and joint oligoarthritis, enthesitis, and sometimes, mucocutaneous, ocular, and/or cardiac manifestations 
    • Spondyloarthritis (SpA) is characterized by articular inflammation, erosion and new bone formation at peripheral and axial sites
      • Strong tendency to affect the spine, especially the sacroiliac joints
  • Divided into 2 subgroups, depending on the presence of sacroiliitis on plain radiography:
    • Ankylosing spondylitis or radiographic axial SpA - features sacroiliitis
    • Non-radiographic axial SpA - absence of sacroiliitis

Definition

  • Ankylosing spondylitis (AS) is a prototype of SpA, particularly of the axial form of SpA
  • Most common inflammatory disorder involving the axial skeleton
  • Predominantly seen in male individuals

Signs and Symptoms

Main Clinical Manifestations of Axial Spondyloarthritis

  • Inflammatory chronic back pain persisting for >3 months confirmed by 4 of the following:
    • Onset before 40 years of age
    • Insidious onset
    • Improves with exercise
    • Nocturnal pain with improvement upon getting up
    • Associated with morning stiffness not improved by rest
  • Synovitis
  • Peripheral arthritis
  • Ankylosis
  • Dactylitis (finger or toe inflammation resulting in a sausage appearance)
  • Inflammation of the attachments of ligaments and tendons to bones (enthesitis)
  • Extra-articular manifestations: Anterior uveitis, psoriasis, inflammatory bowel disease (IBD)

Clinical Manifestations of Ankylosing Spondylitis

  • Inflammatory chronic back pain
  • Chest pain/costochondritis
  • Alternate buttock pain
  • Acute anterior uveitis
  • Asymmetric oligoarthritis predominantly of lower limbs
  • Enthesitis (eg heel, plantar)
  • Radiographic sacroiliitis
  • Positive family history of AS, chronic inflammatory bowel disease (IBD) or psoriasis

Clinical Manifestations of Non-Radiographic Axial Spondyloarthritis

  • Vertebrae structural abnormalities are less severe in non-radiographic axial SpA than advanced AS
  • There is a higher prevalence of occurrence of enthesitis in non-radiographic axial SpA than AS
  • Dactylitis 
  • Asymptomatic ileac and colonic mucosal ulcerations (occurs in 50% of patients)
  • Psoriasis (occurs in 10% of patients)
Editor's Recommendations
Special Reports