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ANKYLOSING SPONDYLITIS
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.

Introduction

  • Axial spondyloarthritis (SpA) refers to a group of inflammatory diseases characterized by spinal and joint oligoarthritis, enthesitis, and sometimes, mucocutaneous, ocular, and/or cardiac manifestations 
    • Spondyloarthritis 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 or radiographic SpA - features sacroiliitis
    • Non-radiographic SpA- absence of sacroiliitis

Definition

  • Ankylosing spondylitis (AS) is a prototype of spondyloarthritis (SpA), particularly of the axial form of SpA

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
  • Inflammation of the attachments of ligaments and tendons to bones (enthesitis)
  • Synovitis
  • Peripheral arthritis
  • Ankylosis
  • Dactylitis or sausage digits
  • Anterior uveitis

Clinical Manifestations of Ankylosing Spondylitis

  • Inflammatory chronic back pain
  • Chest pain/costochondritis
  • Alternate buttock pain
  • Acute anterior uveitis
  • Synovitis predominantly of lower limbs, asymmetric
  • Enthesitis (eg heel, plantar)
  • Radiographic sacroiliitis
  • Positive family history of ankylosing spondylitis (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 spondyloarthritis than advanced AS
  • There is a higher prevalence of occurrence of enthesitis in non-radiographic axial spondyloathritis than AS
  • Dactylitis 
  • Asymptomatic ileac & colonic mucosal ulcerations (occurs in 50% of patients)
  • Psoriasis (occurs in 10% of patients)
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