Battle 6.1: ankylosing spondylitis
Battle 6.2: acute iritis
Battle 6.3: Reiters syndrome
Battle 6.4: pleural effusion
Battle 6.5 yellow nail syndrome
Lets get started!
6.1: Ankylosing spondylitis
Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine and sacroiliac joints.
It affects males more than females, intially around 6:1 but altering to around 2:1 by the age of 30.
95% of patients are + for HLA B27
Patients often present with low back pain which is worse at night and improves on moving.
Clinically, the things to observe on regarding a patient with AS are:
- a loss of lumbar lordosis
- a fixed kyphosis which is compensated by extension of the cervical spine leading to the classical
- 'question mark' posture
- if the patient turns their head to the side, the whole body may turn
- there may be decreased chest expansion forcing increased diaphragmatic excursion and hence a
- prominent abdomen
Associations of AS include:
- aortic regurgitation
- fibrosis (rare)
- cardiac conduction abnormalities (around 10%, mostly long PR)
- secondary amyloidosis
Management is keeping mobile, NSAIDs and in severe cases tumour necrosis factor alpha blockers such as infliximab.
As an aside, if considering a TNF alpha blocker its a good idea to check TB status as it is likely to reactivate latent TB.