Ankylosing

spondylitis
Wirman Halim
20080310185

Anatomy of the spine

Introduction
Ankylosing spondylitis(AS, from Greekankylos,

stiff;spondylos, vertebrae), previously known

asBekhterew's disease,Bekhterev syndrome, and
Marie-Strmpell disease, a form of spondyloarthritis,
is a chronic, inflammatoryarthritisand
autoimmune disease.It mainly affects joints in the
spine and thesacroiliac jointin thepelvis, and can
cause eventual fusion of the spine. It is a member of
the group of thespondyloarthropathieswith a
stronggenetic predisposition. Complete fusion
results in a complete rigidity of the spine, a
condition known as "bamboo spine".

Ankylosing spondylitis
form of chronic inflammation of the spine and

the sacroiliac joints.

Chronic inflammation in these areas causes
pain and stiffness in and around the spine.
chronic inflammation of the spine (spondylitis)
can lead to a complete cementing together
(fusion) of the vertebrae, a process referred to
as ankylosis. Ankylosis leads to loss of
mobility of the spine.

Etiology
No specific causes
As a genitically (HLA-B27)determined

immunopathological disorder
People who have gene HLA-B27 are at
significantly increase risk of developing
ankylosing spondylitis.

Risk factor
Sex: Males are affected more frequently than

females
Age: between 15 and 25 years.
Heredity: most people who have ankylosing
spondylitis have the HLA-B27 gene.

Pathology
Pathological changes proceed in three stages:
(1) an inflammatory reaction with cell

infiltration, granulation tissue formation and

erosion of adjacent bone;
(2) replacement of the granulation tissue by
fibrous tissue; and
(3) ossification of the fibrous tissue, leading to
ankylosis of the joint.

CLINICAL FEATURES
backache and stiffness are worse in the early

morning and after inactivity.

Referred pain in the buttocks and thighs
pain and stiffness continuous general
fatigue, pain and swelling of joints, tenderness
at the insertion of the Achilles tendon,
intercostal pain and tenderness

Early on, slight flattening of the lower back

and limitation of extension in the lumbar

spine. There may be diffuse tenderness over
the spine and sacroiliac joints, or
(occasionally) swelling and tenderness of a
single large joint.

 A. Limited extension of the dorsal and cervical spine.

B. and C. Straightening and rigidity of the lumbar spine

when the patient is asked to flex the trunk.

Extraskeletal manifestations
Iritis
uveatis

X-ray

Ankilosing
spondylitis x-ray,
an early sign is
squaring of the
lumbar
vertebrae.

Ankylosing spondilytis- bony bridge (syndesmophytes) between

the vertebral bodies convert the spine into a rigid column.

TREATMENT
educate the patient
general measures to maintain satisfactory

posture and preserve movement;

anti-inflammatory drugs to counteract pain
and stiffness;
the use of TNF inhibitors for severe disease
operations to correct deformity or restore
mobility

COMPLICATIONS
Spinal fractures
Hyperkyphosis
Spinal cord compression
Lumbosacral nerve root compression

Thank you