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Chronic seronegative inflammatory arthritis primarily affects axial skeleton (sacroiliac joints and vertebrae) and peripheral joints.  Morning  stifness > 1 hour; imporves with exercise.

  • HLA-B27
  • M > F

Signs and symptoms

Axial

  • lower back pain
  • stiffness of back
  • Pain radiates to the buttock – persistant buttock pain
  • painful sacroiliac joint
  • Flattening of lumbar curvature
  • Decreased cheast expansion – respiratory difficulty

Peripheral

  • enthesitis (heel-Achilles tendon)

Extraarticular

  • Cardiac – aortic insufficiency –> CHF
  • anterior uveitis
  • AV block (III degree)
  • GIT – IBD

Dx

  • + FABER TEST (Flexion, ABduction and External Rotation): painful sacroiliac joint
  • + SCHOBER TEST:  measures spine flexion —-> decrease spine mobility
  • Postural changes: increase thoracic kyphosis and decrease lumbar lordosis
    posture-in-ankylosing-spondylitis

    posture in ankylosing spondylitis

     

  • X-ray:  Fusion of the sacroiliac spine; Bamboo spine; squaring of the vertebral bodies, calcification
  • Accurate test is MRI
  • Elevated CRP, ESR

Tx

  • Excercise (swimming), deep breathing exercise, no smoking
  • NSAID
  • Anti-TNF (infliximab, adalimumab, etanercept)
  • DMARD (Sulfasalazine, MTX)
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