Ankylosing spondylitis - Revision history

Elcatracho: /* Clinical Features */

2021-02-10T15:44:59Z

Clinical Features

← Older revision		Revision as of 15:44, 10 February 2021
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	**Can cause morning stiffness lasting more than 30 minutes		**Can cause morning stiffness lasting more than 30 minutes
	*Fatigue		*Fatigue
	*Can also be associated with anterior [[uveitis]], [[arthritis]], ~~bowel ulcers~~ and [[spine fractures]] (4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>)		*Can also be associated with anterior [[uveitis]], [[arthritis]], [[psoriasis]], enthesitis, [[IBD]] and [[spine fractures]] (4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>)

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 23:20, 17 October 2019

2019-10-17T23:20:42Z

← Older revision		Revision as of 23:20, 17 October 2019
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	==Clinical Features==		==Clinical Features==
	*Spinal pain, particularly in the lower back, is usually the first and most common symptom of AS		*[[back pain\|Spinal pain]], particularly in the lower back, is usually the first and most common symptom of AS
	**Begins in early adulthood (before 45 yrs)		**Begins in early adulthood (before 45 yrs)
	**Has a gradual onset		**Has a gradual onset
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	**Can cause morning stiffness lasting more than 30 minutes		**Can cause morning stiffness lasting more than 30 minutes
	*Fatigue		*Fatigue
	*Can also be associated with anterior ~~uvetitis~~, bowel ulcers and ~~spinal~~ fractures ~~are~~ 4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>		*Can also be associated with anterior [[uveitis]], [[arthritis]], bowel ulcers and [[spine fractures]] (4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>)

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Chem 10		*Chem 10
	*[[Urinalysis]]		*[[Urinalysis]]
	*Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by ~~it's self~~ is not specific)		*Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by itself is not specific)

	==Management==		==Management==
	*There is no cure for AS, although treatments and medications can reduce symptoms and pain		*There is no cure for AS, although treatments (e.g. exercise, posture training) and medications can reduce symptoms and pain
	*~~Exercise and posture training should be part of the treatment program for everyone with AS~~		*[[NSAIDS]]
	*NSAIDS		*[[Sulfasalazine]] can be used in people with peripheral arthritis, but for axial involvement, evidence does not support it <ref>Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004800. DOI: 10.1002/14651858.CD004800.pub3.</ref>.
	*Sulfasalazine can be used in people with peripheral arthritis, but for axial involvement, evidence does not support it <ref>Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004800. DOI: 10.1002/14651858.CD004800.pub3.</ref>.
	*Lack of evidence for methotrexate <ref>Chen J, Veras MMS, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004524. DOI: 10.1002/14651858.CD004524.pub4.</ref> or steroids.		*Lack of evidence for methotrexate <ref>Chen J, Veras MMS, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004524. DOI: 10.1002/14651858.CD004524.pub4.</ref> or steroids.
	*Tumor necrosis factor-alpha blockers, such as the biologics etanercept, infliximab, golimumab and adalimumab, provide good short-term effectiveness though long term management is currently being studied		*Tumor necrosis factor-alpha blockers, such as the biologics etanercept, infliximab, golimumab and adalimumab, provide good short-term effectiveness though long term management is currently being studied

Kxl328: /* Background */

2018-11-04T22:38:03Z

Background

← Older revision		Revision as of 22:38, 4 November 2018
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	*Often associated with other autoimmune disorders		*Often associated with other autoimmune disorders
	*90% of people with AS express the HLA-B27 genotype		*90% of people with AS express the HLA-B27 genotype
			*[[Uveitis]] is common extra-articular manifestation, seen in 30% of patients

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T16:34:58Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 16:34, 2 October 2016
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	*CBC		*CBC
	*Chem 10		*Chem 10
	*UA		*[[Urinalysis]]
	*Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by it's self is not specific)		*Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by it's self is not specific)

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T04:19:52Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:19, 22 July 2016
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	{{Lower back pain DDX}}		{{Lower back pain DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*There is no direct test for AS		*There is no direct test for AS
	*ESR, CRP can be elevated but not sensitive or specific		*ESR, CRP can be elevated but not sensitive or specific

ClaireLewis: /* See Also */

2016-07-14T00:52:38Z

ClaireLewis: /* Disposition */

2016-07-14T00:52:22Z

Disposition

← Older revision		Revision as of 00:52, 14 July 2016
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	==Disposition==		==Disposition==
	*Often diagnosis will not be made in ED but if made in ED often can be discharged home with ~~PMD~~ follow up or rheumatology follow up		*Often diagnosis will not be made in ED but if made in ED often can be discharged home with primary care follow up or rheumatology follow up

	==See Also==		==See Also==

Rossdonaldson1: Text replacement - "f/u" to "follow up"

2016-07-12T18:18:32Z

Text replacement - "f/u" to "follow up"

← Older revision		Revision as of 18:18, 12 July 2016
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	==Disposition==		==Disposition==
	*Often diagnosis will not be made in ED but if made in ED often can be discharged home with PMD ~~f/u~~ or rheumatology ~~f/u~~		*Often diagnosis will not be made in ED but if made in ED often can be discharged home with PMD follow up or rheumatology follow up

	==See Also==		==See Also==

Ostermayer: Text replacement - "Category:Rheum" to "Category:Rheumatology"

2016-03-22T16:17:08Z

Text replacement - "Category:Rheum" to "Category:Rheumatology"

← Older revision		Revision as of 16:17, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Rheum~~]]		[[Category:Rheumatology]]

Neil.m.young: shortening phrases for faster reading

2015-11-01T15:20:19Z

shortening phrases for faster reading

← Older revision		Revision as of 15:20, 1 November 2015
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	==Background==		==Background==
	*Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton with variable involvement of other joints or even nonarticular structures.		*Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton with variable involvement of other joints or even nonarticular structures
	* ~~Ankylosing spondylitis is three times~~ more common in males than females~~. It is usually~~ diagnosed in young adults between the ages of 20 and 30 ~~years.~~		*3x more common in males than females
	* Often associated with other autoimmune disorders~~. About~~ 90% of people with AS express the HLA-B27 genotype.		*Typically diagnosed in young adults between the ages of 20 and 30 yrs
			*Often associated with other autoimmune disorders
			*90% of people with AS express the HLA-B27 genotype

	==Clinical Features==		==Clinical Features==
	* Spinal pain, particularly in the lower back, is usually the first and most common symptom of AS.		*Spinal pain, particularly in the lower back, is usually the first and most common symptom of AS
	**Begins in early adulthood (before 45 ~~years of age~~)		**Begins in early adulthood (before 45 yrs)
	**Has a gradual onset		**Has a gradual onset
	**Lasts longer than three months		**Lasts longer than three months
	**Is worse after rest (for example, in the morning) but improves with activity		**Is worse after rest (for example, in the morning) but improves with activity
	**Can cause morning stiffness lasting more than 30 minutes		**Can cause morning stiffness lasting more than 30 minutes
	* Fatigue		*Fatigue
	* Can also be associated with anterior uvetitis, bowel ulcers and spinal fractures are 4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>		*Can also be associated with anterior uvetitis, bowel ulcers and spinal fractures are 4 times more common in patients with AS <ref> Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. European Spine Journal. 2009;18(2):145–156 </ref>

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Lower back pain DDX}}		{{Lower back pain DDX}}

	==Diagnosis==		==Diagnosis==
	*There is no direct test for AS		*There is no direct test for AS
	* ESR, CRP can be elevated but not sensitive or specific ~~for AS~~		*ESR, CRP can be elevated but not sensitive or specific
	* Xray lumbar/sacroiliac: The earliest changes in the sacroiliac joints shows erosions and sclerosis.		*Xray lumbar/sacroiliac: The earliest changes in the sacroiliac joints shows erosions and sclerosis
	**Progression of ~~the~~ erosions leads to pseudo widening of the joint space and bony ankylosis AKA "Bamboo Spine." Often X-ray findings lag about 10 years from initial progression of disease. [[File:5269907670e86d9b415221efa30bf166.jpg\|200px\|thumb\|right\|"bamboo spine"]]		**Progression of erosions leads to pseudo widening of the joint space and bony ankylosis AKA "Bamboo Spine"
	* CBC		Often X-ray findings lag about 10 years from initial progression of disease [[File:5269907670e86d9b415221efa30bf166.jpg\|200px\|thumb\|right\|"bamboo spine"]]
			*CBC
	*Chem 10		*Chem 10
	* UA		*UA
	* Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by it's self is not specific)		*Genetic testing for HLA B27 ( > 90% of people with AS have this gene, though by it's self is not specific)

	==Management==		==Management==
	*There is no cure for AS, although treatments and medications can reduce symptoms and pain		*There is no cure for AS, although treatments and medications can reduce symptoms and pain
	* Exercise and posture training should be part of the treatment program for everyone with AS		*Exercise and posture training should be part of the treatment program for everyone with AS
	* NSAIDS		*NSAIDS
	* Sulfasalazine can be used in people with peripheral arthritis~~. For~~ axial involvement, evidence does not support ~~sulfasalazine~~ <ref>Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004800. DOI: 10.1002/14651858.CD004800.pub3.</ref>.		*Sulfasalazine can be used in people with peripheral arthritis, but for axial involvement, evidence does not support it <ref>Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004800. DOI: 10.1002/14651858.CD004800.pub3.</ref>.
	* Lack of evidence for methotrexate <ref>Chen J, Veras MMS, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004524. DOI: 10.1002/14651858.CD004524.pub4.</ref> or steroids.		*Lack of evidence for methotrexate <ref>Chen J, Veras MMS, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004524. DOI: 10.1002/14651858.CD004524.pub4.</ref> or steroids.
	* Tumor necrosis factor-alpha blockers, such as the biologics etanercept, infliximab, golimumab and adalimumab, ~~have shown~~ good short-term effectiveness ~~in the form of profound and sustained reduction in all clinical and laboratory measures of disease activity. Though~~ long term management is currently being studied.		*Tumor necrosis factor-alpha blockers, such as the biologics etanercept, infliximab, golimumab and adalimumab, provide good short-term effectiveness though long term management is currently being studied

	==Disposition==		==Disposition==
	* Often diagnosis will not be made in ER but if made in ER often can be discharged home with PMD F/U or ~~Close Rheumatology~~ f/u		*Often diagnosis will not be made in ED but if made in ED often can be discharged home with PMD f/u or rheumatology f/u

	==See Also==		==See Also==
			*Arthritis

	==External Links==		==External Links==

← Older revision		Revision as of 00:52, 14 July 2016
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	==See Also==		==See Also==
	*Arthritis		*[[Arthritis]]

	==External Links==		==External Links==