Ankylosing ALSANGEDY

Spondylitis BULLETS™
FOR PACES
 Seronegative chronic
spondyloarthropathy
FOR EASY PASSING PACES FROM
 The most common symptom
THE 1ST ATTEMPT
Insidious onset of low back
pain
Dr. Ibrahim Alsangedy
MRCP-UK, MRCEM-UK, MRCPE, AMC
 Onset of symptoms before CAT (AU), IDHA (USA), M.SC (ICU),
ADDM, HCQM
age 40 years
 Symptoms worse in the
morning or with inactivity
 Improve with exercise

 Starts around the sacroiliac

joints
 Bony fusion & Tendonitis
 Stiffness of the spine and
kyphosis
 Fever, fatigue, and loss of
appetite
 Uveitis
 Aortic valve insufficiency
Workup
 Laboratory Studies
 Anemia of chronic disease
 ESR & CRP elevated
 ALP is elevated
 White patients with AS (92%
HLA-B27 positive)
 Percentage is lower in
patients of other ethnic
backgrounds
 Imaging Studies
 Radiographic evidence of
inflammatory changes both
in the sacroiliac (SI) joints
and in the spine
(pseudowidening) (bamboo
spine appearance)
 MRI or CT scanning of the SI
joints, spine, and peripheral
joints may reveal evidence
of early sacroiliitis,
erosions, and enthesitis
that are not apparent on
standard radiographs
Differential diagnosis Management
 Congenital Spinal Deformity  Major goals of therapy
 Patient education is vital to
 Degenerative Disk Disease familiarize the patient with
the symptoms, course, and
 Herniated Nucleus Pulposus treatment of the disease
 Treatment measures include
 Lumbar Disc Disease pharmacologic, surgical,
and physical therapy
 Lumbar Spondylosis
 Osteoarthritis
 The stepwise approach
 Nonsteroidal anti-
 Osteofibrous Dysplasia
inflammatory drugs
(NSAIDs)
 Psoriatic Arthritis
 Indomethacin is a drug of
choice
 Reactive Arthritis
 Opioid painkillers
 Disease-modifying
Special tests antirheumatic
(DMARDs)
drugs
 Local injection with
(1) Schober's test a useful clinical
corticosteroid
measure of flexion of the lumbar  Tumor necrosis factor-alpha
spine performed during the physical (TNFα)
examination  Joint replacements
 Therapeutic exercises
(2) Occiput-wall distance (OWD)
test