Ankylosing Spondylitis: Complications and Treatment

by Stephen Holt, MD, MS

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    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

    About the Lecture

    The lecture Ankylosing Spondylitis: Complications and Treatment by Stephen Holt, MD, MS is from the course Spondyloarthritides.

    Included Quiz Questions

    1. Diffuse proliferative glomerulonephritis
    2. third-degree heart block
    3. Aortic insufficiency
    4. Inflammatory bowel disease
    5. Anterior uveitis

    Author of lecture Ankylosing Spondylitis: Complications and Treatment

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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