Ankylosing Spondylitis 6/16/2013: Ankylosing Spondylitis 6/16/2013 By: Ashley Harris, Sarah Ervin, Laura Alexander Ankylosing Spondylitis: Ankylosing Spondylitis Ankylosing spondylitis is defined as a chronic inflammatory disease affecting mainly the spine and sacroilliac joints. 1,2 The proximal joints of the lower extremity are usually seen more than the distal joints. 2 Cause remains unknown, but a predisposing genetic factor exists in people of Caucasian descent, 20% of whom actually acquire ankylosing spondylitis 1 Signs and Symptoms: Signs and Symptoms Slow, steady onset of low back pain and stiffness 2 Aggravated by rapid movement but is not relieved by rest 1 Night pain is common 1 Stiffness in the spine is described and continues throughout the day 1,2 Pain gets better with exercise 1,2 Prevalence and Incidence: Prevalence and Incidence Ankylosing Spondylitis occurs most often in early adulthood as young as 10 years of age and is usually rare after the age of 30. 1,2 More common in males than females 2 This disorder is rare amongst the general population with 0.5% prevalence rate. 1 Diagnosis: Diagnosis Upon examination: Local deep tenderness on SI joint and spine 2 Spinal muscle spasms 2 Loss of normal lumbar lordosis 2 After disease has progressed: spine becomes more stiff costovertebral joints are more involved restricting chest inhalation 2 In advanced stages: the stiffness continues to progress and flexion of the spine occurs 2 Prognosis: Prognosis There is no cure for Ankylosing Spondylitis. 1 “Less than 1/3 of the younger patients that were healthy before the disease will acquire the “classic” sign of ankylosing spondylitis” 1 Quality of life is reduced 3 The majority of these patients are able to hold a full time job, but adaptations are necessary to assist in ADL’s. 3 It is important for the therapist to educate the patient on practicing great postural habits of doing daily exercise for the remainder of their life. 1 Impact of Function: Impact of Function In advanced stages, the patient will have difficulty walking and looking straight ahead if the spine becomes fused in flexion. 1 The patients respiratory function is limited due to stiffness of costovertebral joints which causes limited chest expansion 1,3 Role of Imaging and Ankylosing Spondylitis: Role of Imaging and Ankylosing Spondylitis Imaging is one of the most important parts of the examination process with this disease. Imaging allows the physical therapist to visually determine the extent of progression of the disease to better understand safe treatment plan. Ankylosing Spondylitis is seen on a radiograph in the early stages as decreased space of sacroilliac cartilage as well as observation of subchondral sclerosis. 1 In advanced stages, the joints can become ossified leading to the appearance of what is described as “bamboo spine” radiograph imaging. 2 Ossifications can be seen in the spinal ligaments such as anterior and posterior longitudinal ligaments. 2 Best form of Imaging: Ankylosing Spondylitis: Best form of Imaging: Ankylosing Spondylitis The best form of imaging for the detection of ankylosing spondylitis is a radiograph. 3 This is due to a radiographs ability to display the ossification of ligaments distinguishing the difference between a normal radiolucent ligament and an abnormal ossified ligament. Other possible forms of imaging used to diagnose ankylosing spondylitis are computed tomography (CT) and magnetic resonance imaging (MRI). 3 CTs are helpful when trying to distinguish between ankylosing spondylitis and other diseases such as sacroiliitis, when identifying subtleties in radiographic images is necessary. MRIs are used to help detect soft tissue abnormalities. 3 Radiograph displaying Ankylosing Spondylitis: Radiograph displaying Ankylosing Spondylitis http://www.cedars-sinai.edu/Medical-Professionals/Imaging-Center/Musculoskeletal-Radiology/Spine-Survey-MRI-for-Ankylosing-Spondylitis.aspx T2 MRI Image of Lumbar Spine and Sacrum: T2 MRI Image of Lumbar Spine and Sacrum http://emedicine.medscape.com/article/386639-overview#a01 Questions for Classmates: Questions for Classmates List appropriate functional outcome measures that would be used in the clinic for a patient with ankylosing spondylitis. What are modifications that would need to be made at home for a patient with end stage ankylosing spondylitis, and what are some specific functional activities that would require assistance? References: References 1. Salter R. Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd ed. Baltimore, MD: Lippincott Williams and Wilkins. 1999:243-245. 2. Conrad E. Imaging course notes. University of St Augustine. May-August 2013. 3. Diethelm U, Schuler G. Prognosis in anklyosing spondylitis. Schweiz Rundsch Med Prax 1991 May 21; 80(21): 584-7. 4. Brambila-Tapia AJ et al. Pulmonary function in ankylosing spondylitis: association with clinical variables. Rhematol Int. 2013 Mar 30. 5. Peh WC. (2011, April). Imaging in Ankylosing Spondylitis. Medscape Reference . Retrieved June 12, 2013, from http://emedicine.medscape.com/article/386639-overview#a01 .