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Ankylosing Spondylitis axial spondyloarthritis characterized by…
Ankylosing Spondylitis
axial spondyloarthritis characterized by sacroiliitis on x-ray
Causes
Genetically predisposed
Microbiome alterations and abnormal bone formation
Exposure of the immune system to microorganisms
Management in primary care
NSAID's
GI protection (PPI)
Diagnosis criteria
chronic or recurrent low back pain, fatigue, and stiffness
45 years or under
Pain > 3 months
Worse in the morning and improving with movement
Pain is inflammatory and not mechanical
Current or previous
Buttock pain
Pain in thoracic or cervical spine
Arthritis, predominately asymmetric and peripheral
Enthesitis
Anterior uveitis
Psoriasis or inflammatory bowel disease, or genitourinary infection
Symptoms respond to NSAID's
Investigations
ESR +/- CRP
X-Ray
MRI
Diagnostic criteria
Modified New York criteria
ASAS classification criteria for axial spondyloarthritis
Complications
Spinal fractures
Hip disorders
Anterior uveitis (iritis)
Osteoporosis
Cardiac complications
aortic and non-aortic valvular heart disease
Arrhythmia
Congestive heart failure
Dyspnoea
Adverse treatment effects i.e. DMARDS
Decreased quality of life
Differentials
Degenerative or mechanical spinal problems
Fractures
Infectious sacroiiitis
Bone metastases
Primary bone tumours
Spinal stenosis
Hypermobility
Refer Rheumatology
Buttock pain
Improvement when moving
disturbs sleep 2nd half of night
Improvement within 48hrs of starting NSAID's
Low back pain <35 yrs
Spondyloarthritis in a first-degree relative
Current or past arthritis
Current or past enthesitis
Low back pain < 45 yrs for >3 months + 4 or more of following:
Current or past psoriasis
If exactly 3 of the additional criteria are present, perform an HLA-B27 test. If the test is positive, refer the person to a rheumatologist for a spondyloarthritis assessment.