65 yrs old man...h/o of back pain since 3 months.... ESR 55... syndesmophytes present. Diagnosis? (AIIMS Nov 2012)
|B||Degenerative osteoarthritis of spine|
|D||lumber canal stenosis|
Ref: JC Maheshwari, 3rd edition (revised), Page 248
a. Ankylosing spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton; peripheral joints and extraarticular structures are also frequently involved.
b. The disease usually begins in the second or third decade; male to female prevalence is between 2:1 and 3:1. Older names include Marie-Strümpell disease or Bechterew's disease.
c. Modified New York criteria (1984) are classification rather than diagnostic criteria, and they are insensitive in early or mild cases.
These consist of the following:
a. A history of inflammatory back pain
b. Limitation of motion of the lumbar spine in both the sagittal and frontal planes,
c. Limited chest expansion
d. Definite radiographic sacroiliitis. Criterion 4 plus any one of the other three criteria is sufficient for a diagnosis of definite AS.
a. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of pharmacologic therapy for AS.
b. These agents reduce pain and tenderness and increase mobility in many patients with AS. However, many patients with AS have continued symptoms and develop deformity despite NSAID therapy.
c. Dramatic responses to anti-TNF-therapy is reported in patients with AS and other spondyloarthritides.
d. Infliximab, adalimumab have shown rapid, profound, and sustained reductions in all clinical and laboratory measures of disease activity.
e. Degenerative diseases of spine usually leads to more chronic pain and also will show lumbar spondylosis and facetal arthropathy/ apophyseal joints arthropathy.
f. Ankylosing hyperostosis occurs primarily in men > 50 yr and may resemble AS clinically and on x-ray.
g. Patients uncommonly have spinal pain, stiffness, and insidious loss of motion. X-ray findings include large ossifications anterior to spinal ligaments (the calcification appears as if someone poured candle wax in front and on the sides of the vertebrae), bridging several vertebrae and usually starting at the lower thoracic spine, eventually affecting the cervical and lumbar spine.
h. There is often subperiosteal bone growth along the pelvic brim and at insertion of tendons (such as the Achilles tendon insertion). However, the anterior spinal ligament is intact and frequently bulging, and sacroiliac and spinal apophyseal joints are not eroded.
i. Lumbar canal stenosis syndrome consists of neurogenic claudication and symptoms bilateral lower limbs rather than back pain.