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
- Spondyloarthritis (SpA) is characterized by articular inflammation, erosion and new bone formation at peripheral and axial sites
- Divided into 2 subgroups, depending on the presence of sacroiliitis on plain radiography:
- Ankylosing spondylitis (AS) or radiographic axial SpA - features sacroiliitis
- Non-radiographic axial SpA - absence of sacroiliitis
Definition
- 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
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 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 (occur in 50% of patients)
- Psoriasis (occurs in 10% of patients)