Ankylosing apondylitis is associated with -
Ans. is 'a' i.e., HLA-B27 o There is strong correlation with HLA-B27 o 90-95% of cases are positive for HLA - B27.o Extra articular manifestations of ankylosing spondylitis are acute anterior uveitis (in 5%); rarely aortic valve disease, carditis and pulmonary fibrosis also occur.Ankylosing soundvlitis fmarie-strumpell disease)o Ankylosing spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton.o Prototype of seronegative (absence of rheumatoid factor) spondyloarthropathies,o Inflammatory disorder of unknown cause.o Usually begins in the second or third decade with a median age of 23, in 5% symptoms begin after 40.o Male to female ratio is 2-3 : 1o Strong correlation with HLA-B27o 90-95% of cases are positive for HLA - B27.Joints involved in ankylosing spondylitiso Ankylosing spondylitis primarily affects axial skeleton.o The disease usually begins in the sacro-iliac joints and usually extends upwards to involve the lumbar, thoracic, and often cervical spine.o In the worst cases the hips or shoulders are also affected. Hip joint is the most commonly affected peripheral joint.o Rarely knee (Ebenzar 4ft/e 593) and ankle (Apley's 9dVe 67) are also involved. Pathology'o Enthesitis i.e. inflammation of the insertion points of tendons, ligaments or joint capsule on bone is one of the hallmarks of this entity of disease.o Primarily affects axial (spinal) skeleton and sacroiliitis is often the earliest manifestation of A.S.,o Involvement of costovertebral joints frequently occur, leading to diminished chest expansion (normal > 5 cm)o Peripheral joints e.g. shoulders, and hips are also involved in l/3rd patients.o Extraarticular manifestations like acute anterior uveitis (in 5%); rarely aortic valve disease, carditis and pulmonary' fibrosis also occur.o Pathological changes proceed in three stages-Inflammation with granulation tissue formation and erosion of adjacent bone.Fibrosis of granulation tissueOssification of the fibrous tissue, leading to ankylosis of the joint.Radiological features of ankylosing spondylitiso Radiographic evidence of sacroiliac join! is the most consistent finding in ankylosing spondylitis and is crucial for diagnosis. The findings are :-Sclerosis of the articulating surfaces of SI jointsWidening of the sacroiliac joint spaceBony ankylosis of the sacroiliac jointsCalcification of the sacroiliac ligament and sacro-tuberous ligamentsEvidence of enthesopathy - calcification at the attachment of the muscles, tendons and ligaments, particularly around the pelvis and around the heel.o X-ray of lumbar spine may show :-Squaring of vertebrae : The normal anterior concavity of the vertebral body is lost because of calcification of the anterior longitudinal ligament.Loss of the lumbar lordosis.Bridging 'osteophytes' (syndesmophytes)Bamboo spine appearance
HLA-B27
HLA-B-8
HLA - DW4/DR4
HLA - DR3
Other Rheumatic Diseases