ANKYLOSING SPONDYLITIS Defenition : ● It is a chronic inflammatory disease that affect spine and sacroiliac joints characterized by pain and stiffness of the back with variable involvement of hip and shoulder joint , very rarely peripheral joints are involved . Incidence : ● It is more common in men than women. ● Male and female ratio 2 : 1 ● Common age group » 15 to 25 years Etiology : ● The exact etiology of the disease is unknown . ● It is a genetically determined disorder with immunological abnormality. ● Genetic may cause , HLA-B27. Pathology : Inflammation ↓ Subchondral granulation & joint erosion It is replaced by fibrocartilage ↓ Synovitis of sacroiliac joint & vertebral facet joints occurs ↓ The outer fibers of discs eventually undergo ossification to from syndesmophytes ↓ In late stage fibrous ankylosing followed ba bony ankylosing occurs ↓ Inflammation of ligaments & tendons occur in particular on the side of insertion Clinical features : The patient present with the following complaints , ● Diffuse back pain , worse in early morning & prolonged period of inactivity ,improving with activity. ● Pain & swelling of hip or knee or ankle may occur. ● Neck pain & tenderness over spine and sacroiliac joints . ● Spinal movement decrease in all directions . ● In later stage , deformities of the hip and spine may be presenting features , ○ Stiffness ○ Cervical spine involvement is common. ○ Thoracic spine : chest expansion is diminished to < 5cm due to involvement of costovertebral joints . ○ SI joints : tenderness ○ TA and hamstring tightness ● Posture : loss of lumbar lordosis, increased kyphosis ● Last joint affected : temporomandibular joint. Extra articular manifestation : ● Eye : glaucoma , uveitis , conjunctivitis . ● CVS : aortic valve incompetence ,carditis ● Neurological : spinal cord compression ● Respiratory system : restrictive lung disease , pulmonary fibrosis. ● Systemic : osteoporosis, amyloidosis. Spinal involvement in ankylosing spondylitis : Investication : Blood test : ● Raised ESR & CRP ● HLA B27 is positive X ray : ● Anteroposterior view of pelvis » subchondral erosion & sclerosis calcification occurs . ● Lateral view of lumbar spine » squaring of vertebrae. ● Calcification of lateral ligament » bamboo spine appearance . Wall test : ● when the patient stands against the wall with his back he is unable to touch the wall with his head due to stiff cervical spine Aim of treatment : ● Pain relief and control measures ● Maintenance of joint mobility ● Prevention of deformity ● Lifestyle modification . Management : Drugs: ● NSAIDS - n aproxen ● Indomethacin - reduce pain & stiffness ● Sulfasalazine - reduce inflammation ● Corticosteroids Surgery : ● Vertebral osteotomy ● Arthroplasty Physiotherapy : ● Modalities : to relieve pain & muscle spasm ○ Interferential therapy ○ Ultrasound therapy ○ Wax therapy ● Posture correction exercises ● Gait training ● Breathing exercises ● Spinal exercises ● Endurance exercises ● Stretching exercises - for tendo achilles , hamstrings ● Advice the patient to lie on prone before and after sleep. ● Swimming .
