Ankylosing Spondylitis

 

* Also called ankylosing spondylitis. It affects mainly men (3 of 4) begins in the subject young between 18 and 30 years.

Can begun in children from 8 years. More rarely in the elderly. The presence of radiographic signs such as bilateral sacroiliitis or syndesmophytes is an element of certainty (HLA B27 is only a guidance element).

* The entheses (zone insertion of the tendon and capsular structures on the bone) is the prime target; it may also be responsible for synovitis resulting peripheral arthritis.

* The SPA often begins with low back pain, radiating readily to the buttocks. The pain is greatest thing in the morning, if mitigating the morning after prolonged stiffness; he joins in lumbar stiffness sometimes very severe (following the same inflammatory rhythm).

* Sometimes the SPA begins rocking truncated sciatica. Sensitivity to NSAIDs is an important diagnostic argument.

* Evolution is a progressive and final stiffness of all or part of the spine (Schöber index << 15 cm).

* The achievement of the hip is common and often early; it is rarely destructive (can progress to ankylosis). The achievement of the shoulders is rare.

* Peripheral arthritis occurs in about one third of cases, mainly affecting the lower limb joint willingly as oligo- or monoarthritis (asymmetric).

Evolution ankylosing spondylitis

Evolution ankylosing spondylitis

* The heel pain (post, below) are the most frequent enthesopathies; they also have an inflammatory time (maximum thing in the morning or the weight bearing after prolonged rest).

JOINT EXTRA EVENTS:

– Anterior uveitis (recurrent willingly; 20% of cases)

– Aortic regurgitation (1% of cases)

– Branch block (rarely symptomatic)

– Diarrhoea frequently reported (40% of patients present with colonic lesions histologically inflammatory bowel disease close)

* The inflammation is often poorly marked. Or totally absent in almost a quarter of cases.

* The phenotypes HLA B27 (not essential to Dc) is found in 80-90% of cases.

* The achievement of the sacroiliac (radiology) is almost constant. usually bilateral symmetrical +/-. Pubis can be affected in a similar way

Lumbar ankylosing spondylitis

Lumbar ankylosing spondylitis

* In the spine, the earliest lesions are erosions of the vertebral body edges (-> up to the square by clearing the anterior concavity) the first syndesmophytes (ossification of the vertebral ligaments) appear most often … the thoracolumbar junction. -> Bamboo spine

* The hip disease results in joint space narrowing and ossification of péricapitales and acetabular liner …

* The most common enthesopathies are those of the ischial spine, the trochanteric mass and the posterior aspect of the calcaneus.

* Minors forms are the most frequent, often limited to sacroiliitis.

* Complications: fracture of the spine; stress fractures; anterior dislocation of the atlas (risk of cervical compression); syndrome of the ponytail.

* The disease develops most often as the minor mode (late Dec) forms that evolve towards a complete spinal ankylosis, usually have an early onset, change in one piece and are almost exclusively male.

* NSAIDs is the basis of treatment SPA; they are only prescribed during inflammatory processes (once daily in the evening); phenylbutazone (particularly effective in PPS) is used only in case of failure of other NSAIDs (risk of agranulocytosis).

* The basic treatment is not effective for damage pelvirachidienne; it is reserved for devices reached. Sulfasalazine reduce the frequency of relapses of uveitis.

* The surgery is exceptional

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