ankylosing spondylitis

Radiology case 318-74

Radiology case 338-74.html

Last Updated: December 6, 2006
Synonyms and related keywords: ankylosing spondylitis, undifferentiated spondyloarthropathy, Marie-Strümpell disease, von Bechterew disease, von Bechterew's disease, spondyloarthropathies, SpAs, AS, rheumatoid spondylitis, USpA, peripheral enthesitis, sacroiliitis, Schober test, cauda equina syndrome, dactylitis, European Spondyloarthropathy Study Group criteria, Amor criteria, New York criteria, Rome criteria, Romanus lesion, bamboo spine, fused spine, Reiter syndrome, Reiter's syndrome, reactive arthritis, ReA, RS, psoriatic arthritis, PsA, Whipple disease, Behçet disease, uveitis, iritis, iridocyclitis
Contents: Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography
Author: Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Background: The spondyloarthropathies (SpAs) are a family of related disorders that includes ankylosing spondylitis (AS), Reiter syndrome (RS), reactive arthritis (ReA), psoriatic arthritis (PsA), spondyloarthropathy associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthropathy (USpA), and, possibly, Whipple disease and Behçet disease. Ankylosing spondylitis is the prototypical SpA and its name means "inflamed spine growing together." It has been designated by various names, including rheumatoid spondylitis in the American literature, spondyloarthrite rhizomegalique in the French literature, and the eponyms Marie-Strümpell disease and von Bechterew disease.

Images from eMedicine articles on Ankylosing Spondylitis

Synonyms and related keywords: ankylosing spondylitis, Marie-Strümpell arthritis, Bechterew disease, spondyloarthritis, spondyloarthropathy, chronic inflammatory conditions, AS, inflammation of the joints, inflammation of the tendons, inflammation of the ligaments, iritis, uveitis, aortitis, pulmonary fibrosis, amyloidosis, inflammatory bowel disease
Author: Alan Schaffert, MD, Past Chief of Staff, Doctor's Medical Center of Modesto; Voluntary Clinical Faculty, Department of Medicine, University of California at Davis
Spondyloarthritis or spondyloarthropathy refers to a group of chronic inflammatory conditions affecting the joints, tendon and ligament attachments, and sometimes nonskeletal structures. Ankylosing spondylitis (AS) is one of these inflammatory diseases. It primarily affects the axial joints, including the spine and sacroiliac joints. It causes eventual fusion of the spine. Peripheral joints may be involved.

Authors: S Craig Humphreys, MD, Jason C Eck, DO, MS, Scott D Hodges, DO
Contents - Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography
Synonyms and related keywords: AS, Marie-Strumpell disease, von Bechterew disease, rheumatoid spondylitis, seronegative spondyloarthropathy, reactive arthritis, psoriasis, juvenile chronic arthritis, ulcerative colitis, Crohn disease, Crohn's disease, human leukocyte antigen B27, HLA-B27

Author: Wilfred CG Peh, MBBS, MHSM, MD, FRCPE, FRCPG, FRCR, Clinical Professor, Faculty of Medicine, National University of Singapore; Senior Consultant Radiologist, Programme Office, Singapore Health Services
Contents - Introduction Differentials Radiograph CT Scan MRI Nuclear Medicine Intervention Pictures Bibliography
Ankylosing spondylitis is a distinct disease entity characterized by inflammation of multiple articular and para-articular structures, frequently resulting in bony ankylosis. The term ankylosing is derived from the Greek word ankylos, meaning stiffening of a joint, while spondylos means vertebra. Spondylitis refers to inflammation of one or more vertebrae. Ankylosing spondylitis usually is classified as a chronic and progressive form of seronegative arthritis. Ankylosing spondylitis has a predilection for the axial skeleton, affecting particularly the sacroiliac and spinal facet joints and the paravertebral soft tissues. Extraspinal manifestations of the disease include peripheral arthritis, iritis, pulmonary involvement, and systemic upset.

Search for Medscape pages with Ankylosing Spondylitis in the Title

Fact Sheet; Type "Ankylosing Spondylytis" [without quotes] in search box at this Web Site for additional information.

Overview of this spinal arthritic condition includes anatomy (with diagrams), causes, symptoms, diagnosis, and treatment options. Commercial

Disussion:

- patients with ankylosing spondylitis are prone to C-spine fracture following minor trauma;
- acute neck pain in a patient with ankylosing spondylitis is usually caused by a fracture through the ankylosed spine;
- site of involvement is most commonly near cervicothoracic junction (or C6-7);
- the fracture may extend thru the disc space or may extend thru all columns;
- there may be significant change in neck alignment;
- epidural hematoma may contribute to spinal cord injury;

J Am Acad Orthop Surg, Vol 13, No 4, July/August 2005, 267-278. Full Text available to members. Abstract free
Erik N. Kubiak, MD, Ronald Moskovich, MD, Thomas J. Errico, MD and Paul E. Di Cesare, MD
Ankylosing spondylitis is an inflammatory disease of unknown etiology that affects an estimated 350,000 persons in the United States and 600,000 in Europe, primarily Caucasian males in the second through fourth decades of life. Worldwide, the prevalence is 0.9%. Genetic linkage to HLA-B27 has been established. Ankylosing spondylitis primarily affects the axial skeleton and is characterized by inflammation and fusion of the sacroiliac joints, spine, and hips. The resultant deformity leads to severe functional impairment in approximately 30% of patients. Orthopaedic management primarily involves correction of hip deformity through total hip arthroplasty and, less frequently, correction of spinal deformity with spine osteotomy. Closing wedge osteotomies have the lowest incidence of complications. Whether patients with ankylosing spondylitis are at increased risk for heterotopic ossification remains controversial, but comparison with age- and sex-matched counterparts suggests no dramatically higher risk. Because of the high rate of missed fractures and complications after minor trauma in patients with ankylosing spondylitis, plain radiographs are usually not sufficient for evaluation. Thorough patient assessment should include a comprehensive history, physical examination, and laboratory studies.

Ann Rheum Dis 1998;57:429-433 ( July ) Full text
Ossification of the posterior longitudinal ligament in three geographically and genetically different populations of ankylosing spondylitis and other spondyloarthropathies
CONCLUSIONSThe prevalence of OPLL in AS and SpA is higher than previously recognised and seems to be associated with variables identifying more severe axial disease.

Wheeless' Textbook of Orthopaedics
Clinical Findings:

- loss of lumbar lordosis;
- back motion is limited;
- note that ability to lean forward has more to do with hip flexion than lumbar spine flexion;
- w/ forward flexion there should be a reversal of the normal lumbar lordosis;
- hip flexion contractures or cervicothoracic kyphosis is common;
- these conditions require correction;
- may have fixed cervical, thoracic, or lumbar hyperkyphosis;
- may cause marked functional limitations, primarily due to inability of affected patients to face forward;
- pts may have diminished chest expansion;