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
- 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