Ankylosing Spondylitis

Presentation:

  • Age  < 45 yo
  • AM stiffness < 30 minutes – better with movement/exercise
  • Nighttime awakening from pain (second half of night)
  • Key features: inflammatory back pain, enthesitis, dactylitis, uveitis, positive family history for axial spondyloarthritis, IBD, alternating buttock pain, psoriasis, asymmetric arthritis, + response to NSAIDs, elevated CRP or ESR
  • Longtime sxs -> osteoporosis -> increased fx risk

Dx: 3 month hx back pain < 45 yo in addition to below

  • Radiographic Sacroilitis
  • > 4 key features = dx
    • < 4 key features + HLA-B27 = dx
    • < 4 key features + negative HLA + positive MRI = dx
  • 2-3 key features + HLA-B27 = dx
    • 2-3 key feature + negative HLA-B27 + positive MRI = dx
  • 0-1 key feature + HLA-B27 + MRI = dx

Tx:

  • First line: NSAIDs or COX-2 inhibitors
  • Second line (no NSAIDS): TNF-inhibitors
  • Localized sxs: glucocorticoid injections (sparingly)

Sources:

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