Diagnosis and treatment of ankylosing spondylitis

1. What are the lab findings in AS?
2. What are the radiographic findings in AS?
3. What physical exam test is used in AS?
4. What is the non-drug treatment for AS?
5. What medications are used to treat AS?


Answers:
1. 90% have +HLA B27, incr ESR/CRP, anemia (normocytic, normochromic), RF-, ANA-.
2. SI joint narrowing, pseudowidening of joint space due to subchondral bone resorption and erosion sclerosis, bamboo spine, syndesmophyte formation (squaring of lumbar vertebrae's anterior concavity), osteopenia, straightening of C-spine.
3. Schober test: place landmark midline at a pt 5cm below iliac crest and 10cm above. On forward flexion, the line should increase to greater than 20cm. Any less is a restriction.
4. Good posture, firm mattress, prevent flexion contractures, PT (extension exercises), deep breathing exercises, no smoking.
5. NSAIDs (indocin), steroid (taper, PO, injections, eye drops), sulfasalazine, methotrexate.