00:00
Few other complications just to be mindful
of an Ankylosing Spondylitis.
00:04
We already talked
about conjunctivitis,
but a worst diagnosis would
be anterior uveitis.
00:10
In general, patients with Ankylosing Spondylitis
should be mindful
that they may develop Psoriatic
plaques over time.
00:15
This is a representative photo of
Guttate Psoriasis.
00:20
Of course, again, because
these are all
sort of part of the same
Spondyloarthritis family,
she may develop some inflammatory
bowel disease
type symptoms down
the road.
00:30
Lastly, Aortic insufficiency is one
of the later manifestations
as well as third degree heart AV block and
that's something to be mindful of
in terms of following her cardiovascular
system over time.
00:41
Alright. Disappointed with
her diagnosis,
she certainly wants to know what
her treatment options are.
00:47
Well, a big part of the equation
is to quit smoking,
because smoking is only going to contribute
and exacerbate symptoms over time.
00:54
Physical Therapy is important
you have to keep moving.
00:56
This is a stiffness
disease
and keeping moving will reduce
the stiffness that develops.
01:01
Then amazingly, despite this being a very
complicated immune mediated disease,
basic NSAIDs have been shown
to be the staple treatment
for all of the
Spondyloarthritides.
01:11
You want to use
high doses.
01:13
Any NSAID honestly will do. And it's
been shown as I mentioned
to be highly effective in particular
for ankylosing spondylitis.
01:20
70 to 80% of patients will need no
other additional treatments.
01:25
If you do need additional
treatments,
you can use things like
TNF inhibitors,
infliximab, adalimumab,
etanercept, etc.
01:33
With that our girl rocker
can hopefully
get back to touring keep
her fans happy.
01:40
A few key points about
Ankylosing Spondylitis.
01:43
First, it's a chronic indolent arthritis
of the axial skeleton,
most commonly afflicting patients
under the age of 40.
01:51
Symptoms characterized by nocturnal back
pain like our patient describe,
she'll be afraid to go to bed because she'd
wake up with terrible back pain
during the middle of the night
have to walk around.
02:01
Morning stiffness of course
goes along with that.
02:04
You may see eye involvement,
peripheral joints,
tendons like the
Achilles tendon
and others and systemic manifestations
may be present.
02:13
This is a seronegative
spondyloarthropaty,
which just means that rheumatoid
factor ought to be negative.
02:19
There may be some nonspecific inflammatory
markers like an ESR
and this is the spondyloarthritide that is most
associated with the HLA b 27 alleles.
02:30
Lastly, NSAIDs they
really work.
02:32
If you need to, you can move
on to TNF inhibitors