Ankylosing Spondylitis

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Ankylosing spondylitisWirman Halim 20080310185Anatomy of the spine

Introduction Ankylosing spondylitis(AS, from Greekankylos, stiff;spondylos, vertebrae), previously known asBekhterew's disease,Bekhterev syndrome, and Marie-Strmpell disease, a form of spondyloarthritis, is a chronic, inflammatoryarthritisandautoimmune disease.It mainly affects joints in thespine and thesacroiliac jointin thepelvis, and can cause eventual fusion of the spine. It is a member of the group of thespondyloarthropathieswith a stronggenetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine".

3Ankylosing spondylitisform of chronic inflammation of the spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine.chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis leads to loss of mobility of the spine.

Etiology No specific causesAs a genitically (HLA-B27)determined immunopathological disorderPeople who have gene HLA-B27 are at significantly increase risk of developing ankylosing spondylitis.

Risk factorSex: Males are affected more frequently than females Age: between 15 and 25 years.Heredity: most people who have ankylosing spondylitis have the HLA-B27 gene.PathologyPathological changes proceed in three stages: (1) an inflammatory reaction with cell infiltration, granulation tissue formation and erosion of adjacent bone; (2) replacement of the granulation tissue by fibrous tissue; and (3) ossification of the fibrous tissue, leading to ankylosis of the joint.

CLINICAL FEATURES backache and stiffness are worse in the early morning and after inactivity. Referred pain in the buttocks and thighs pain and stiffness continuous general fatigue, pain and swelling of joints, tenderness at the insertion of the Achilles tendon, intercostal pain and tenderness

Early on, slight flattening of the lower back and limitation of extension in the lumbar spine. There may be diffuse tenderness over the spine and sacroiliac joints, or (occasionally) swelling and tenderness of a single large joint.

A. Limited extension of the dorsal and cervical spine. B. and C. Straightening and rigidity of the lumbar spine when the patient is asked to flex the trunk.

Extraskeletal manifestations IritisuveatisX-rayAnkilosing spondylitis x-ray, an early sign is squaring of the lumbar vertebrae.

Ankylosing spondilytis- bony bridge (syndesmophytes) between the vertebral bodies convert the spine into a rigid column.

TREATMENTeducate the patient general measures to maintain satisfactory posture and preserve movement; anti-inflammatory drugs to counteract pain and stiffness;the use of TNF inhibitors for severe diseaseoperations to correct deformity or restore mobility COMPLICATIONSSpinal fractures HyperkyphosisSpinal cord compressionLumbosacral nerve root compression

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