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Ankylosing Spondylitis 720

 

synonyms:

Anklylosing Spondylitis ICD-9

  • 720 Ankylosing spondylitis and other inflammatory spondylopathies
  • 720.0 Ankylosing spondylitis

Anklylosing Spondylitis Etiology / Epidemiology / Natural History

  • Chronic inflammatory disease characterised by back pain and progressive stiffness.
  • Generally adult males age 20-30y/o.
  • HLA-B27 postive in @95%.
  • Linked to the inflammatory cytokine TNF-alpha.

Anklylosing Spondylitis Anatomy

Anklylosing Spondylitis Clinical Evaluation

  • Back pain with prolonged morning stiffness. Deep-seated night pain,
  • Progressive axial spine stiffness / loss of motion.
  • Other common findings: sacroliliac pain, hip arthritis, enthesitis, arthritis
  • Stooped posture: neck flesion, throacic kyphosis, loss of lumbar lordosis.

Anklylosing Spondylitis Xray / Diagnositc Tests

  • Lumbar/thoracic spine: Squaring of vertebral bodies, bridging syndesmophytes, ankylosis of the facet joits and calcificaiton of the anterior logitudinal ligament,
  • C-spine xrays: anterior antlantoaxial subluxation late in disease.
  • Labs: elevated ESR (80% of patients), elevated CRP, negative rheumatoid factor, negative antinuclear antibody.

Anklylosing Spondylitis Classification / Treatment

  • TNF-alpha Antagonists: Infliximab, etanerceopt, adalimumab have demonstrated efficacy in treateing AS. Generally done under the care of a rheumatologist.
  • Celebrex (Wanders A, Arthritis Rheum 2005;52:1756).
  • Trauma: pateitns with ankylosing spondylitis are prone to distraction-extension injuries to the spine, most commonly the cervicothoracic juntion. These injuries are highly unstable, frequently missed, occur with minimal trauma and prone to neurologic deterioration. Treatment = mulitlievel posterior fusion.

Anklylosing Spondylitis Associated Injuries / Differential Diagnosis

  • Osteoarthritis
  • Fibromyalgia
  • Psoriatic Arthritis
  • Ankylosing Spondylitis
  • Rheumatoid Arthritis

Anklylosing Spondylitis Complications

  • Adverse medication reactions: TB reactivation, pneumoxystis carinii, candidiasis, histoplasmosis, listeriosis, nocardiosis, aspergillosis, cytomegalovirus, cryptococcosis, coccidioidmyocosis, demyelinating disease, infusion/injection reactions, malignancy, CHF

Anklylosing Spondylitis Follow-up Care

  • Generally refer to rheumatology for medical management.

Anklylosing Spondylitis Review References

 

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