Ankylosing spondylitis- Golden Points

►Ankylosing spondylitis is the most frequent seronegative inflammatory spinal disease in adults and the prototype for other members of the spondyloarthropathies.

►The symptoms of the disease are usually first noticed in late adolescence or early adulthood; the median age in Western countries is 23. In 5% of patients, symptoms begin after age 40. 

►Sacroiliitis is often the earliest manifestations of AS. 

►The most important gene in ankylosing spondylitis is HLAB27.
In most populations, it is present in more than 90% of
patients and in less than 10% of the general population.

►Ankylosing spondylitis is the most common association with iritis in young patients, particularly men.

►The most common extraarticular manifestation is acute anterior uveitis, which occurs in 40% of patients and can antedate the spondylitis. 

►Aortic dilatation and aortic regurgitation may be present in approximately 10% of patients. 

►-Ankylosing spondylitis is associated with IgA nephropathy

►Entheseal involvement most frequently occurs at sites
rich in fibrocartilage such as the Achilles tendon.

►The girdle or “root” joints (hips and shoulders) are the most
frequently involved extra-axial joints in AS, and pain in
these areas is the presenting symptom in up to 15% of
patients.

►No laboratory test is diagnostic of AS. In most ethnic groups, HLA-B27 is present in 80–90% of patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often, but not always, elevated. 

►The most common indication for surgery in patients with AS is severe hip joint arthritis, the pain and stiffness of which are usually dramatically relieved by total hip arthroplasty. 

►-Only 5% of those with Ankylosing spondylitis have Inflammatory bowel. But FIFTY percent have mucosal ulcerations!

►Neurologic complications of AS can be caused by fracture,
instability, compression, or inflammation. Traffic accidents
or minor trauma can cause spinal fractures. The C5-C6 or
C6-C7 level is the most commonly involved site.

►The most common pulmonary manifestation of ankylosing spondylitis is ILD (MC upper lobe)

►Radiographically demonstrable sacroiliitis is eventually present in AS. The earliest changes by standard radiography are blurring of the cortical margins of the subchondral bone, followed by erosions and sclerosis. 

►Golimumab is a TNF inhibitor useful for Ankylosing spondylitis. 
This disease is the ONLY time a TNF inhibitor is the FIRST line of therapy

►Methotrexate does not work for the Axial skeleton such as ankylosing spondylitis. it is for peripheral joints such as RA and psoriatic arthritis