True about ankylosing spondylitis are all except ?
Ans. is 'c' i.e., 90% HLA-B5 Ankylosing spondylitis (marie-strumpell disease) Ankylosing spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton. rototype of seronegative (absence of rheumatoid factor) spondyloahropathies. Inflammatory disorder of unknown cause. Usually begins in the second or third decade with a median age of 23, in 5% symptoms begin after 40. Male to female ratio is 2-3 : 1 Strong correlation with HLA-B270-95% of case 9s are positive for HLA - B27. Joints involved in ankylosing spondylitis Ankylosing spondylitis primarily affects axial skeleton. The disease usually begins in the sacro-iliac joints and usually extends upwards to involve the lumbar, thoracic, and often cervical spine. In the worst cases the hips or shoulders are also affected. Hip joint is the most commonly affected peripheral joint. Rarely knee (Ebenzar 4th/e 593) and ankle (Apley's 9thle 67) are also involved. Pathology Enthesitis i.e. inflammation of the inseion points of tendons, ligaments or joint capsule on bone is one of the hallmarks of this entity of disease. Primarily affects axial (spinal) skeleton and sacroiliitis is often the earliest manifestation of A.S.. Involvement of costoveebral joints frequently occur, leading to diminished chest expansion (normal _ 5 cm) Peripheral joints e.g. shoulders, and hips are also involved in 1/3rd patients. Extraaicular manifestations like acute anterior uveitis (in 5%); rarely aoic valve disease, carditis and pulmonary fibrosis also occur. Pathological changes proceed in three stages? Inflammation with granulation tissue formation and erosion of adjacent bone. Fibrosis of granulation tissue Ossification of the fibrous tissue, leading to ankylosis of the joint. Radiological features of ankylosing spondylitis Radiographic evidence of sacroiliac joint is the most consistent finding in ankylosing spondylitis and is crucial for diagnosis. The findings are :- Sclerosis of the aiculating surfaces of SI joints Widening of the sacroiliac joint space Bony ankylosis of the sacroiliac joints Calcification of the sacroiliac ligament and sacro-tuberous ligaments Evidence of enthesopathy - calcification at the attachment of the muscles, tendons and ligaments, paicularly around the pelvis and around the heel. X-ray of lumbar spine may show :- Squaring of veebrae : The normal anterior concavity of the veebral body is lost because of calcification of the anterior longitudinal ligament. ft Loss of the lumbar lordosis. Bridging `osteophytes' (syndesmophytes) Bamboo spine appearance
Affects males
3 0-40yrs
90% HLA-B5
Bamboo spine
90% HLA-B5