Spondyloarthropathy--AS: Difference between revisions

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'''Original Editors '''  
'''Original Editors '''  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
</div>  
</div>  
== Search Strategy  ==
== Search Strategy  ==


Keywords: spondyloartrhropathy, ankylosing spondylitis, Reiter's syndrome, Marie-Strumpell disease, bamboo spine<br>Databases: PubMed, Pedro, Web of Science, emedicine<br><br>
Keywords: spondyloartrhropathy, ankylosing spondylitis, Reiter's syndrome, Marie-Strumpell disease, bamboo spine<br>Databases: PubMed, Pedro, Web of Science, emedicine<br><br>  


== Definition/Description  ==
== Definition/Description  ==
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<br>[[Ankylosing Spondylitis|Ankylosing Spondylitis (AS) also]] known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.<ref name="2">Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.</ref> AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.<ref name="22" /><br>  
<br>[[Ankylosing Spondylitis|Ankylosing Spondylitis (AS) also]] known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.<ref name="2">Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.</ref> AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.<ref name="22" /><br>  


[[Image:Spondy 1.png|center|Fig. 1]]
[[Image:Spondy 1.png|center|Fig. 1]]  


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==
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The vertebral column exists of 24 vertebrae: seven [[Cervical Vertebrae|cervical vertebrae]], twelve thoracic vertebrae and five [[Lumbar Vertebrae|lumbar vertebrae]]. The vertebrae are joined together by ligaments and separated by intervertebral discs. The discs exist of an inner nucleus pulposus and an outer annulus fibrosis, consisting of fibrocartilage rings.<br>Patients with spondyloarthropathy have a high propensity for inflammation at the sites where tendons, ligaments and joint capsules attach to the bone. These sites are known as entheses. <ref name="23">Benjamin M. and McGonagle D., The anatomical basis for disease localization in seronegative spondyloarthropathy at entheses and related sites. J. Anat., 2001. Level of Evidence 5</ref>Level 5<br>  
The vertebral column exists of 24 vertebrae: seven [[Cervical Vertebrae|cervical vertebrae]], twelve thoracic vertebrae and five [[Lumbar Vertebrae|lumbar vertebrae]]. The vertebrae are joined together by ligaments and separated by intervertebral discs. The discs exist of an inner nucleus pulposus and an outer annulus fibrosis, consisting of fibrocartilage rings.<br>Patients with spondyloarthropathy have a high propensity for inflammation at the sites where tendons, ligaments and joint capsules attach to the bone. These sites are known as entheses. <ref name="23">Benjamin M. and McGonagle D., The anatomical basis for disease localization in seronegative spondyloarthropathy at entheses and related sites. J. Anat., 2001. Level of Evidence 5</ref>Level 5<br>  


The&nbsp;[[Sacroiliac joint|sacroiliac joint]] consists of a cartilaginous part and a fibrous (or ligamentous) compartment with very strong anterior and posterior sacroiliac ligaments. This makes the SIJ an amphiarthrosis with movement restricted to slight rotation and translation. Another specific feature of the SIJs is that two different types of cartilage cover the two articular surfaces. While the sacral cartilage is purely hyaline, the iliac side is covered by a mixture of hyaline and fibrous cartilage. Due to its fibrocartilaginous components, the sacroiliac joint is a so-called articular enthesis.<ref name="24">Hermann K.G.A., Bollow M., Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology. Fortschr Röntgenstr, 2014, 186:3, 230-237 Level of Evidence 1B</ref>Level 1B
The&nbsp;[[Sacroiliac joint|sacroiliac joint]] consists of a cartilaginous part and a fibrous (or ligamentous) compartment with very strong anterior and posterior sacroiliac ligaments. This makes the SIJ an amphiarthrosis with movement restricted to slight rotation and translation. Another specific feature of the SIJs is that two different types of cartilage cover the two articular surfaces. While the sacral cartilage is purely hyaline, the iliac side is covered by a mixture of hyaline and fibrous cartilage. Due to its fibrocartilaginous components, the sacroiliac joint is a so-called articular enthesis.<ref name="24">Hermann K.G.A., Bollow M., Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology. Fortschr Röntgenstr, 2014, 186:3, 230-237 Level of Evidence 1B</ref>Level 1B  


== Epidemiology /Etiology  ==
== Epidemiology /Etiology  ==


Ankylosing spondylitis (the most common spondyloarthropathy) has a prevalence of 0.1 to 0.2 percent in the general U.S. population and is related to the prevalence of HLA-B27. Diagnostic criteria for the spondyloarthropathies have been developed for research purposes, the criteria rarely are almost not used in clinical practice. There is no laboratory test to diagnose ankylosing spondylitis but the HLA-B27 gene has been found to be present in about 90 to 95 percent of affected white patients in central Europe and North America <ref name="22" />Level 5
Ankylosing spondylitis (the most common spondyloarthropathy) has a prevalence of 0.1 to 0.2 percent in the general U.S. population and is related to the prevalence of HLA-B27. Diagnostic criteria for the spondyloarthropathies have been developed for research purposes, the criteria rarely are almost not used in clinical practice. There is no laboratory test to diagnose ankylosing spondylitis but the HLA-B27 gene has been found to be present in about 90 to 95 percent of affected white patients in central Europe and North America <ref name="22" />Level 5  


<br>AS is 3 times more common in men than in women and most often begins between the ages of 20-40.<ref name="5">Beers MH, et. al. eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.</ref>&nbsp;<ref name="22" />&nbsp;(Level 5) Recent studies have shown that AS may be just as prevalent in women, but diagnosed less often because of a milder disease course with fewer spinal problems and more involvement of joints such as the knees and ankles. Prevalence of AS is nearly 2 million people or 0.1% to 0.2% of the general population in the United States. It occurs more often in Caucasians and some Native American than in African Americans, Asians, or other nonwhite groups.<ref name="1" /> AS is 10 to 20 times more common with first degree relatives of AS patients than in the general population. The risk of AS in first degree relatives with the HLA-B27 allele is about 20%.<ref name="5" />&nbsp;<br>[[Image:Tabel.png|center|Table 1]]<br>
<br>AS is 3 times more common in men than in women and most often begins between the ages of 20-40.<ref name="5">Beers MH, et. al. eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.</ref>&nbsp;<ref name="22" />&nbsp;(Level 5) Recent studies have shown that AS may be just as prevalent in women, but diagnosed less often because of a milder disease course with fewer spinal problems and more involvement of joints such as the knees and ankles. Prevalence of AS is nearly 2 million people or 0.1% to 0.2% of the general population in the United States. It occurs more often in Caucasians and some Native American than in African Americans, Asians, or other nonwhite groups.<ref name="1" /> AS is 10 to 20 times more common with first degree relatives of AS patients than in the general population. The risk of AS in first degree relatives with the HLA-B27 allele is about 20%.<ref name="5" />&nbsp;<br>[[Image:Tabel.png|center|Table 1]]<br>  


== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


The most characteristic feature of spondyloarthropathies is inflammatory back pain. Another characteristic feature is enthesitis, which involves inflammation at sites where tendons, ligaments, or joint capsules attach to bone.<ref name="22" /> Level 5 <ref name="25">Van der Linden S, van der Heijde D. Ankylosing spondylitis. In: Ruddy S, Harris ED Jr, Sledge CB, eds. Kelley’s Textbook of rheumatology. 6th ed. Philadelphia: Saunders, 2001:1039-54. Level of Evidence 5</ref>&nbsp;Level 5 <br>Additional clinical features include inflammatory back pain, dactylitis, and extra-articular manifestations such as uveitis and skin rash.<ref name="22" /> Level 5<br><br>There can also be buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.<ref name="1" /> It is mostly worse in the morning, lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.<ref name="2" />
The most characteristic feature of spondyloarthropathies is inflammatory back pain. Another characteristic feature is enthesitis, which involves inflammation at sites where tendons, ligaments, or joint capsules attach to bone.<ref name="22" /> Level 5 <ref name="25">Van der Linden S, van der Heijde D. Ankylosing spondylitis. In: Ruddy S, Harris ED Jr, Sledge CB, eds. Kelley’s Textbook of rheumatology. 6th ed. Philadelphia: Saunders, 2001:1039-54. Level of Evidence 5</ref>&nbsp;Level 5 <br>Additional clinical features include inflammatory back pain, dactylitis, and extra-articular manifestations such as uveitis and skin rash.<ref name="22" /> Level 5<br><br>There can also be buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.<ref name="1" /> It is mostly worse in the morning, lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.<ref name="2" />  


Paravertebral muscle spasm, aching, and stiffness are common, making sacrioliac areas and spinous process very tender upon palpation.<ref name="1" /> A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.<ref name="5" /> <br>
Paravertebral muscle spasm, aching, and stiffness are common, making sacrioliac areas and spinous process very tender upon palpation.<ref name="1" /> A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.<ref name="5" /> <br>  


Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.<ref name="2" /> Dactylitis (inflammation of an entire digit), commonly termed “sausage digit,” also occurs in the spondyloarthropathies and is thought to arise from joint and tenosynovial inflammation <ref name="22" />&nbsp;Level 5.<br>Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.<ref name="1" />
Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.<ref name="2" /> Dactylitis (inflammation of an entire digit), commonly termed “sausage digit,” also occurs in the spondyloarthropathies and is thought to arise from joint and tenosynovial inflammation <ref name="22" />&nbsp;Level 5.<br>Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.<ref name="1" />  


In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.<ref name="2" />
In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.<ref name="2" />  


Anterior uveitis is the most frequent extra-articular manifestation, occurring in 25 to 30 percent of patients. The uveitis usually is acute, unilateral, and recurrent. Eye pain, red eye, blurry vision, photophobia, and increased lacrimation are presenting signs. Cardiac manifestations include aortic and mitral root dilatation, with regurgitation and conduction defects. Fibrosis may develop in the upper lobes of the lungs in patients with longstanding disease. <ref name="26">Sieper J., et al. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002;61, 8-18. Level of Evidence 5</ref>&nbsp;Level 5<br><br>
Anterior uveitis is the most frequent extra-articular manifestation, occurring in 25 to 30 percent of patients. The uveitis usually is acute, unilateral, and recurrent. Eye pain, red eye, blurry vision, photophobia, and increased lacrimation are presenting signs. Cardiac manifestations include aortic and mitral root dilatation, with regurgitation and conduction defects. Fibrosis may develop in the upper lobes of the lungs in patients with longstanding disease. <ref name="26">Sieper J., et al. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002;61, 8-18. Level of Evidence 5</ref>&nbsp;Level 5<br><br>  


<h2> Differential Diagnosis  </h2>
== Differential Diagnosis ==
<p>Most Common differential diagnosis<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="2" />
</p>
<ul><li>Rheumatoid arthritis
</li><li>Psoriasis
</li><li>Reiter's syndrome
</li><li>Fracture
</li><li>Osteoarthritis
</li><li>Inflammatory bowel disease [27]&nbsp;:&nbsp;Ulcerative colitis and Crohn’s disease<br />
</li><li>Psoriatic spondylitis [27]
</li><li>Scheuermann’s disease [27]
</li><li>Paget’s disease [27] Level 5
</li></ul>
<p><br /> Differential Diagnosis of Ankylosing Spondylitis and Thoracic Spinal Stenosis[17]
</p>
<table width="720" border="1" align="left" cellpadding="1" cellspacing="1">


<tr>
Most Common differential diagnosis<ref name="2" />
<th scope="col">
 
</th><th scope="col"> Ankylosing Spondylitis
*Rheumatoid arthritis
</th><th scope="col"> Thoracic Spînal Stenosis
*Psoriasis
</th></tr>
*Reiter's syndrome
<tr>
*Fracture
<th scope="row"> History
*Osteoarthritis
</th><td>
*Inflammatory bowel disease [27]&nbsp;:&nbsp;Ulcerative colitis and Crohn’s disease<br>
<p>Morning stiffness<br />Intermittend aching pain<br />Male predominance<br />Sharp pain<br />Bilateral sacroiliac pain may refer to posterior thigh  
*Psoriatic spondylitis [27]
</p>
*Scheuermann’s disease [27]
</td><td> Intermittent aching pain<br />Pain may refer to both legs with walking
*Paget’s disease [27] Level 5
</td></tr>
 
<tr>
<br> Differential Diagnosis of Ankylosing Spondylitis and Thoracic Spinal Stenosis[17]
<th scope="row"> Active movements
 
</th><td> Restricted
{| width="720" border="1" align="left" cellpadding="1" cellspacing="1"
</td><td> May be normal
|-
</td></tr>
! scope="col" |
<tr>
! scope="col" | Ankylosing Spondylitis  
<th scope="row"> Passive movements
! scope="col" | Thoracic Spînal Stenosis
</th><td> Restricted
|-
</td><td> May be normal
! scope="row" | History  
</td></tr>
|
<tr>
Morning stiffness<br>Intermittend aching pain<br>Male predominance<br>Sharp pain<br>Bilateral sacroiliac pain may refer to posterior thigh  
<th scope="row"> Resisted isometric<br />movements
 
</th><td> Normal
| Intermittent aching pain<br>Pain may refer to both legs with walking
</td><td> Normal
|-
</td></tr>
! scope="row" | Active movements  
<tr>
| Restricted  
<th scope="row"> Special tests
| May be normal
</th><td> None
|-
</td><td> <a href="Bicycle test of Van Gelderen">Bicycle test of van Gelderen</a>&nbsp;may be positive<br />Stoop test may be positive
! scope="row" | Passive movements  
</td></tr>
| Restricted  
<tr>
| May be normal
<th scope="row"> Reflexes
|-
</th><td> Normal
! scope="row" | Resisted isometric<br>movements  
</td><td> May be affected in long standing cases
| Normal  
</td></tr>
| Normal
<tr>
|-
<th scope="row"> Sensory deficit
! scope="row" | Special tests  
</th><td> None
| None  
</td><td> Usually temporary
| [[Bicycle_test_of_Van_Gelderen|Bicycle test of van Gelderen]] may be positive<br>Stoop test may be positive
</td></tr>
|-
<tr>
! scope="row" | Reflexes  
<th scope="row"> Diagnostic imaging
| Normal  
</th><td> Plain films arre diagnostic
| May be affected in long standing cases
</td><td> Computed tomography scans&nbsp;are diagnostic
|-
</td></tr></table>
! scope="row" | Sensory deficit  
| None  
| Usually temporary
|-
! scope="row" | Diagnostic imaging  
| Plain films arre diagnostic  
| Computed tomography scans&nbsp;are diagnostic
|}
 
==  ==
 
==  ==
 
==  ==
 
==  ==
 
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==  ==
 
==  ==


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


add text here related to medical diagnostic procedures
add text here related to medical diagnostic procedures  


== Outcome Measures ==
== Outcome Measures ==


add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])
add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])  


== Examination  ==
== Examination  ==

Revision as of 20:28, 1 February 2017

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

Top Contributors - Adam Bockey, Elise Jespers, Elaine Lonnemann, Kim Jackson, Admin, 127.0.0.1, WikiSysop, Wendy Walker and Lucinda hampton  

Search Strategy[edit | edit source]

Keywords: spondyloartrhropathy, ankylosing spondylitis, Reiter's syndrome, Marie-Strumpell disease, bamboo spine
Databases: PubMed, Pedro, Web of Science, emedicine

Definition/Description[edit | edit source]

Spondyloarthropathies are a diverse group of inflammatory arthritides that share certain genetic predisposing factors and clinical features. The group primarily includes Ankylosing Spondylitis, reactive arthritis (including Reiter’s syndrome), psoriatic arthritis, inflammatory bowel disease–associated spondyloarthropathy, and undifferentiated spondyloarthropathy.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5

The primary pathologic sites are the sacroiliac joints, the bony insertions of the annulus fibrosis of the intervertebral discs, and the apophyseal joints of the spine.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Ankylosing Spondylitis (AS) also known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Fig. 1

Clinically Relevant Anatomy[edit | edit source]

The vertebral column exists of 24 vertebrae: seven cervical vertebrae, twelve thoracic vertebrae and five lumbar vertebrae. The vertebrae are joined together by ligaments and separated by intervertebral discs. The discs exist of an inner nucleus pulposus and an outer annulus fibrosis, consisting of fibrocartilage rings.
Patients with spondyloarthropathy have a high propensity for inflammation at the sites where tendons, ligaments and joint capsules attach to the bone. These sites are known as entheses. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleLevel 5

The sacroiliac joint consists of a cartilaginous part and a fibrous (or ligamentous) compartment with very strong anterior and posterior sacroiliac ligaments. This makes the SIJ an amphiarthrosis with movement restricted to slight rotation and translation. Another specific feature of the SIJs is that two different types of cartilage cover the two articular surfaces. While the sacral cartilage is purely hyaline, the iliac side is covered by a mixture of hyaline and fibrous cartilage. Due to its fibrocartilaginous components, the sacroiliac joint is a so-called articular enthesis.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleLevel 1B

Epidemiology /Etiology[edit | edit source]

Ankylosing spondylitis (the most common spondyloarthropathy) has a prevalence of 0.1 to 0.2 percent in the general U.S. population and is related to the prevalence of HLA-B27. Diagnostic criteria for the spondyloarthropathies have been developed for research purposes, the criteria rarely are almost not used in clinical practice. There is no laboratory test to diagnose ankylosing spondylitis but the HLA-B27 gene has been found to be present in about 90 to 95 percent of affected white patients in central Europe and North America Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleLevel 5


AS is 3 times more common in men than in women and most often begins between the ages of 20-40.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title (Level 5) Recent studies have shown that AS may be just as prevalent in women, but diagnosed less often because of a milder disease course with fewer spinal problems and more involvement of joints such as the knees and ankles. Prevalence of AS is nearly 2 million people or 0.1% to 0.2% of the general population in the United States. It occurs more often in Caucasians and some Native American than in African Americans, Asians, or other nonwhite groups.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title AS is 10 to 20 times more common with first degree relatives of AS patients than in the general population. The risk of AS in first degree relatives with the HLA-B27 allele is about 20%.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

Table 1


Characteristics/Clinical Presentation[edit | edit source]

The most characteristic feature of spondyloarthropathies is inflammatory back pain. Another characteristic feature is enthesitis, which involves inflammation at sites where tendons, ligaments, or joint capsules attach to bone.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5
Additional clinical features include inflammatory back pain, dactylitis, and extra-articular manifestations such as uveitis and skin rash.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5

There can also be buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title It is mostly worse in the morning, lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Paravertebral muscle spasm, aching, and stiffness are common, making sacrioliac areas and spinous process very tender upon palpation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Dactylitis (inflammation of an entire digit), commonly termed “sausage digit,” also occurs in the spondyloarthropathies and is thought to arise from joint and tenosynovial inflammation Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5.
Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Anterior uveitis is the most frequent extra-articular manifestation, occurring in 25 to 30 percent of patients. The uveitis usually is acute, unilateral, and recurrent. Eye pain, red eye, blurry vision, photophobia, and increased lacrimation are presenting signs. Cardiac manifestations include aortic and mitral root dilatation, with regurgitation and conduction defects. Fibrosis may develop in the upper lobes of the lungs in patients with longstanding disease. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Level 5

Differential Diagnosis[edit | edit source]

Most Common differential diagnosisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

  • Rheumatoid arthritis
  • Psoriasis
  • Reiter's syndrome
  • Fracture
  • Osteoarthritis
  • Inflammatory bowel disease [27] : Ulcerative colitis and Crohn’s disease
  • Psoriatic spondylitis [27]
  • Scheuermann’s disease [27]
  • Paget’s disease [27] Level 5


Differential Diagnosis of Ankylosing Spondylitis and Thoracic Spinal Stenosis[17]

Ankylosing Spondylitis Thoracic Spînal Stenosis
History

Morning stiffness
Intermittend aching pain
Male predominance
Sharp pain
Bilateral sacroiliac pain may refer to posterior thigh

Intermittent aching pain
Pain may refer to both legs with walking
Active movements Restricted May be normal
Passive movements Restricted May be normal
Resisted isometric
movements 		Normal Normal
Special tests None Bicycle test of van Gelderen may be positive
Stoop test may be positive
Reflexes Normal May be affected in long standing cases
Sensory deficit None Usually temporary
Diagnostic imaging Plain films arre diagnostic Computed tomography scans are diagnostic

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Diagnostic Procedures[edit | edit source]

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Outcome Measures[edit | edit source]

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Examination[edit | edit source]

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Medical Management
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Physical Therapy Management
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