ANKYLOSIS SPONDYLITIES

Generalised chronic inflammatory disease mainly involving spine and sacroiliac joints, hips, shoulder M>F onset 15-25 years.
Family history, genetic predisposition.

Clinical features  

Early presentation:

Early morning low backache.
Radiating pain to buttocks.
Pain over insertion of tendo-achillis insertion over the heel

Late presentation:

Loss of lumbar lordosis
Increased Thoraxic Kyphosis, Forward thrust of the neck.
Hip and knees in slightly flexed and later fixed.
Chest expansion> 7 am
Peripheral joint less involvement.

X-Ray

Erosion R. Fuzziness of the sacroiliac joints.
Periarticular sclerosis.
Squaring of vertebral bodies.
‘Bamboo Spine’
Peripheral joints shows – Erosion arthritis or progressive bony ankylosis.

 
Investigation:

ESR – Increased
HLAB 27 – (+) in 90% of cases
RA - Negative

Treatment:         

IMaintaining good posture and flexibility
Encouraging spinal extension exercises, swimming, and gymnastics’.
Pain killers and anti inflammatory drugs – Indomethacin is effective
Operative intervention in late presentations. In the form of joint replacement.

   
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