Disease Information for Ankylosing spondylitis (Marie-Strumple): Definition

  • Ankylosing Spondylitis Syndrome: Essentials of Diagnosis: Chronic low backache in young adults, generally worst in the morning; Progressive limitation of back motion and of chest expansion; Transient (50%) or permanent (25%) peripheral arthritis; Anterior uveitis in 20–25%; Diagnostic radiographic changes in sacroiliac joints; Elevated ESR and negative serologic tests for rheumatoid factor; HLA-B27 testing is most helpful when there is an indeterminate probability of disease; Ankylosing spondylitis is a chronic inflammatory disease of the joints of the axial skeleton, manifested clinically by pain and progressive stiffening of the spine; The age at onset is usually in the late teens or early 20s; The incidence is greater in males than in females, and symptoms are more prominent in men, with ascending involvement of the spine more likely to occur;Clinical Findings- Symptoms and Signs: The onset is usually gradual, with intermittent bouts of back pain that may radiate down the thighs; As the disease advances, symptoms progress in a cephalad direction and back motion becomes limited, with the normal lumbar curve flattened and the thoracic curvature exaggerated; Chest expansion is often limited as a consequence of costovertebral joint involvement; Radicular symptoms due to cauda equina fibrosis may occur years after onset of the disease; In advanced cases, the entire spine becomes fused, allowing no motion in any direction; Transient acute arthritis of the peripheral joints occurs in about 50% of cases, and permanent changes in the peripheral joints—most commonly the hips, shoulders, and knees—are seen in about 25%;

    Spondylitic heart disease, characterized chiefly by atrioventricular conduction defects and aortic insufficiency, occurs in 3–5% of patients with longstanding severe disease; Anterior uveitis is associated in as many as 25% of cases and may be a presenting feature (see photograph); Pulmonary fibrosis of the upper lobes, with progression to cavitation and bronchiectasis mimicking tuberculosis, may occur, characteristically long after the onset of skeletal symptoms; Constitutional symptoms similar to those of rheumatoid arthritis are absent in most patients;

    --[Medical Access Website Current DXRX Medical article 2005]--------------