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Ankylosing spondylitis: a term describing a group of clinically…
Ankylosing spondylitis: a term describing a group of clinically heterogeneous inflammatory rheumatologic conditions. It may be axial, affecting the sacroiliac joints and the spine, or peripheral.
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Diagnosis
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minimum of three month history of lower back pain, limited movement in the spine and limited chest expansion movement
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Assessment- Hx taking, family Hx, PMHx
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Signs &Symptoms
Chronic back pain (often inflammatory in nature) and stiffness that improves with exercise, not rest. Worse in the morning
Sacroiliac joint and spinal fusion. New bone formation leads to sacroiliac joint ankylosis and the formation of syndesmophytes (bony growths in intervertebral joint ligaments) in the spine.
Arthritis and enthesitis — the most common peripheral manifestations (predominantly in the lower limbs with asymmetrical distribution).
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Extra-articular manifestations (for example anterior uveitis, psoriasis, inflammatory bowel disease).
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Treatment
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Medication for symptom management including paracetamol, codeine if required and NSAIDs. (PPI cover)
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DMARDS may be used in treatment and can be initiated by rheumatology. Primary care can arrange and carry out routine bloods for chronic disease management with ongoing joint working with rheumatology as required.
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Differentials
Degenerative or mechanical problems (most common) — for example degenerative disc disease, spondylosis, congenital vertebral anomalies, degenerative changes in the intevertebral (facet) joints, osteoarthritis of sacroiliac joints.
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