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Ankylosing Spondylitis

Written by
Dr. Saswati Nanda
and medically reviewed by iCliniq medical review team.

Published on Aug 24, 2016 and last reviewed on Sep 07, 2018   -  3 min read

Abstract

Abstract

This article discusses about the causes, pathology, clinical features, musculoskeletal manifestation, investigation and management of ankylosing spondylitis.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory autoimmune disorder of the spine characterized by pain and stiffness with a variable course. It mainly affects the joints of the spine and sacroiliac joint in the pelvis. As the severity increases, the joints start to fuse with each other resulting in a rigid spine.

Causes:

It is thought to be genetic. The disease is more common with HLA-B27 in their first relatives such as father or mother. HLA-B27 is also present in individuals without ankylosing spondylitis development. Therefore, it is thought that there must be some other associated triggering factor responsible for the disease.

It is often associated with genitourinary or with gastrointestinal infection.

Pathology:

Antigen-antibody reaction triggers the inflammatory process. Inflammation is present at bone-ligament and bone-tendon junctions. There also occurs synovitis of synovial joints of the body, such as sacroiliac joint, hip joint, facet joint, etc. Joint becomes swollen and the movements of joints are limited. Destruction of articular cartilage occurs over time, followed by the subchondral bone formation.

The costovertebral joints are frequently involved with limitation of chest expansion. Inflammation of bone-ligament junctions affect the sacroiliac ligaments, intervertebral joints, symphysis pubis and manubrium sterni. The inflammatory reaction is characterized by cellular infiltration, granulation tissue formation and erosion of the adjacent bones. Granulation tissue is replaced by fibrous tissue, which gets ossified over time leading to ankylosis of the joint.

Ossification of the longitudinal ligament results in syndesmophytes. Syndesmophytes between two adjacent vertebral body bridges limit the movement and as a result the spine becomes stiff like bamboo. And so we call it as bamboo spine.

Clinical Features:

Extra Musculoskeletal Manifestations:

  1. It includes ocular inflammation in above one-third of the patients.
  2. Carditis.
  3. Aortic valve disease.
  4. Pulmonary fibrosis.

Investigations:

  1. X-ray - The cardinal sign in the early stage is the erosion of the sacroiliac joint and later periarticular sclerosis develops usually on the iliac side of the joint. Sclerosis will be present in the x-ray.
  2. ESR - Erythrocyte sedimentation rate increases during active stage.
  3. Presence of HLA-B27 in 90% of cases.

Management:

Stay healthy and fit with regular exercise and say goodbye to drugs.

To know more about ankylosing spondylitis, consult an ankylosing spondylitis specialist online -->https://www.icliniq.com/ask-a-doctor-online/pain-medicine-physician/ankylosing-spondylitis

 

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Last reviewed at:
07 Sep 2018  -  3 min read

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Dr. Saswati Nanda

Dr. Saswati Nanda

Bachelor in physiotherapy

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