Ankylosing Spondylitis

30 years old male computer software engineer has presented with back stiffness since 1 year.

kindly proceed!

History: present complain

since when pain ,progression,no of joints involved,any rash,if back pain then any radiation,

associated symptoms: eye symptoms,breathing difficulty,syncope,other joint pain

exam: neck flexion,extension,lateral movement,schooner’s test,reduced chest expansion and protuberant abdomen due to diaphragmatic breathing,? posture,fixed thoracic kyphoscoliosis,loss of lumbar lordosis,extension of cervical spine, auscultate for apical fibrosis,

hows it affecting his daily routine,is he able to cook ,wash ,bath and drive? can he drive? how it has affected his work?if he is working

complication:

5 As

Anterior uveitis

Apical fibrosis

AV conduction block( pt may have infraclavicular scarf ICD placement)

Arthritis ( large joint)

Aortic regurgitation: look for sternotomy scar

mention absence of abdominal scar ,absence of rash to r/0 IBD,Psoriasis.

other cause of back pain could be  trauma ,mechanical,seronegative arthropathy.

what to say to patient:

Based upon what you have told me and examination i did ,it appears that you have an inflammatory condition called Ankylosing Spondylitis.its basically manifest as neck and back pain.we are going to do some blood test to see the degree of inflammation and X-ray of your back /spine and we may also need to do more sophisticated scan of spines such as MRI .mean while i will prescribe some pain killers i.e. NSAID to help with pain ,as you told me the symptoms are affecting daily activity hence i will speak to GP to refer you for occupational therapist and physiotherapist.i will also make arrangement for you to be seen in rheumatology clinic with the test result.

at this point do you have any questions for me?

What is the diagnosis?

How would you manage this patient?

Plain xray spine: to look for bilateral sacroiliitis,syndesmophyte

MRI L-S spine

ESR,CRP

HLAB27

ECG TO LOOK FOR CONDUCTION BLOCK

2D ECHO: TO CONFIRM AORTIC REGURGITATION

NSAIDs: SPECIALLY INDOMETACIN

TNF-aLpha inhibitors—adalimumab,infliximab,golimumab,etanercept

what are the side effects of Biological agents?

beside nausea ,vomitting and diarrhea,injection site reaction other side effects are reactivation of pulmonary tuberculosis ,fungal infection.

need to do screening for HIV,HCV,HBV before starting the treatment.

Suppose this patient presented to a neurologist with acute pain in back,what would be the cause???

>Dural ectasia !