Ankylosing spondylitis: Year of the Zebra 2024

Chapters:

Watch video only

Introduction0:00–1:14

Ankylosing spondylitis or as for short, is a chronic inflammatory condition that primarily affects the spine and sacroiliac joints which connect the pelvis to the lower spine.
In as inflammation primarily affects the vertebral joints in the spine. Specifically the points where ligaments, tendons and joint capsules attach to bone.
Chronic inflammation causes new bone to form along the outer edges of the spine. Now, the affected part of the spine becomes more rigid, limiting its range of motion.
As the condition progresses, the bony outgrowths grow bigger until they form bridges among adjacent vertebrae causing ankylosis or fusion of the entire spine.
The exact cause of inflammation in a is unclear, but it's thought to be due to an autoimmune process which is when the immune system attacks its own tissue.
In this case, the collagen found in the joints while no autoantibody has been specifically linked to the disease. Most individuals with as carry the gene HLA B 27 which plays a key role in helping the body distinguish between its own cells and foreign substances.
The most common symptom of as is chronic back pain and stiffness, especially in the lower back and buttocks. The pain and stiffness are usually worse in the morning and improve with activity, not rest over time.

Clinical Manifestations1:14–2:16

Pain can extend up the spine and cause neck or upper back pain and immobility because the ribs and vertebrae are involved in breathing stiffness in the thoracic or chest region of the spine can result in shortness of breath.
The autoimmune process underlying as can lead to pain in tendons and peripheral joints such as the hips, knees and ankles.
It can also lead to several other extraarticular manifestations such as anterior uveitis, causing painful red eyes with increased sensitivity to light.
Other important manifestations include inflammatory bowel disease, pulmonary fibrosis, psoriasis, heart blocks and aortic inflammation which can potentially lead to aortic aneurysm and dissection diagnosis of ankylosing spondylitis is based on a combination of clinical findings and imaging and laboratory tests.

Diagnosis2:16–3:03

Initially, x rays of the spine may reveal inflammation of the sacroiliac joints. In later stages, the classic bamboo spine appearance may be seen due to spinal fusion in cases where X ray findings are normal but the clinical suspicion for as is still high.
An MR may be performed as Mris can detect early inflammatory changes in the sacro iliac joints before they become visible on X ray.
Other tests that support the diagnosis of as include elevated inflammatory blood markers, a negative rheumatoid factor and a positive HLA B 27 antigen.
Now, inflammation and pain from a can be treated with nonsteroidal anti inflammatory drugs like ibuprofen or naproxen if pain doesn't improve.

Treatment3:03–3:39

After a few weeks, individuals may be treated with biologic agents like etanercept or secukinumab, which block the effects of specific inflammatory mediators for individuals that are unresponsive to these medications.
Local steroid injections may be administered in the affected joints for pain control. Finally, regular exercise and physical therapy are important to help maintain proper mobility and posture.
All right. As a quick recap, ankylosing spondylitis is a chronic inflammatory condition that can lead to fusion of the vertebrae resulting in a rigid spine.

Review3:39–4:08

Some of the symptoms seen in as include back pain, buttock, pain and pain in the peripheral joints such as the hips, knees and ankles.
Diagnosis is based on a combination of clinical and imaging findings. Treatment involves anti inflammatory medications and biologic agents as well as maintaining a regular exercise routine.