Ankylosing Spondylitis M45.9 720



Anklylosing Spondylitis ICD-10

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.
  • Ankylosing spondylitis patients are at high risk for heterotopic ossification after total hip arthroplasty. Perioperative prophylaxis with NSAIDs or radiation therapy is indicated. Radiation prophylaxis of 700 to 800 centigray given within 24 hours preoperatively is effective.
  • Ankylosing spondylitis patients have @20% incidence of heterotopic ossification after TKA. (Parvizi J, JBJS 83A;1312-1316.)

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