Ankylosing Spondylitis Overview Quiz

Pelvis

• Conditions related to the pelvis include ankylosing spondylitis, coccygodynia, meralgia paresthetica, and pubalgia.

C/O-Medical records

• This section outlines the crucial steps in medical record management, from patient initial complaint (C/O) through to final plan (Rx1).

Ankylosing spondylitis

• Characterised as a chronic form of arthritis, often affecting the spine (spondyloarthropathy).
• Bamboo-shaped spine is a common feature, often with inflammation, leading to spinal fusion, and a stooped posture.
• 80% of patients experience axial symptoms.
• Typically affecting the lumbopelvic spine.

Spondyloarthropathies classification

• Seronegative arthritis / peripheral spondyloarthritis is associated with Crohn's disease or ulcerative colitis, characterized by: peripheral, symmetrical, and bilateral involvement of joints like knees, ankles, elbows, and wrists.
• Enteropathic arthritis/spondyloarthritis progress independently of the primary intestinal disease. Predisposition is shown to HLA-B27 but less than in ankylosing spondylitis.
• Differentiated spondyloarthritis : Includes peripheral arthritis, sacroiliitis, and enthesitis with inflammatory low back pain. Diagnostic classification is often unclear or cannot be definitively established with imaging tests alone.
• Reactive arthritis / Polyarticular. Asymmetric, commonly affecting feet and peripheral joints, mostly characterized by pain in the hindfoot.

AS incidence

• Lumbopelvic joint is frequently affected, as well as the lumbar vertebrae.
• Areas where ligaments and tendons attach to bones, especially in the spine.
• Cartilage between the sternum and ribs can also be impacted.
• Hip and shoulder joints can also be affected.

Coccygodynia

• Defined as pain in or around the tailbone (coccyx).
• Often with undefined spreading of pain.
• Higher frequency in women (5:1).

Coccygodynia: Involved factors

• Traumatic origin – local trauma.
• Prolonged sitting, especially on hard surfaces.
• Other factors: arthritis, childbirth.
• Obesity listed as a risk factor.

TP pelvic floor

• This section describes tenderness spots in the pelvis and their locations.

Coccygodynia: 24-hour behavior

• Pain while sitting worsens with leaning backward.
• Pain during bowel movements or sexual intercourse.
• Pain can be reduced with particular cushions.

Coccygodynia: Current and past history

• To reduce symptoms: leaning forward when sitting, and using pressure-reducing cushions (sometimes wedge-shaped).
• Applying heat or ice.
• Medication.
• Symptoms can resolve in weeks with rest.
• Prolonged sitting should be avoided.

Coccygodynia: Special questions

• Trauma in area (direct or indirect) should be investigated.
• Bowel or urination problems, or any sexual difficulties should be explored..
• If using cushions to reduce symptoms, continuing that practise is recommended.
• Upright sitting should be maintained to avoid recurrence of symptoms.

Meralgia paresthetica

• Mononeuropathy (sensory-only) of the femorocutaneous nerve.
• Often caused by injury or entrapment, mainly at the inguinal level.
• The condition is more common in people aged between 30 and 40, without a gender bias.
• Incidence rate of 4.3 per 10,000 people in a given region.

Meralgia paresthetica: Factors Involved

• Idiopathic.
• Mechanical causes – conditions that increase abdominal pressure, situations where the nerve is compressed.
• Metabolic factors –type 2 diabetes, alcoholism.
• Iatrogenic causes– during hip, lumbar spine, abdominal, obstetric, gynaecological surgery.

Meralgia paresthetica: Past and Present Background

• Obesity.
• Pregnancy.
• Tight fitting clothing.
• Surgery

Meralgia paresthetica: Special questions

• Differential diagnosis includes: metastasis at the iliac crest, lumbar disc herniation, avulsion fracture, chronic appendicitis, spinal surgery and diabetes.
• Differentiate from trochanteritis.

Meralgia paresthetica: Prognosis

• 62% of cases resolve spontaneously.
• Conservative measures are effective for 90% of cases.
• 73% of infiltration cases improve completely; relapse rate is 7%.
• Cases caused by compression, posture adjustment, or tissue retraction have quicker recovery times than direct injury.

Pubalgia

• This is not a specific diagnosis. It is a generic term used to describe groin pain.
• Different etiologies are involved, including sports hernia, sportsman’s hernia, sportsman’s groin, Gilmore’s groin, athletic pubalgia, and core muscle injury.
• Different aspects of groin pain should be considered as a differential diagnosis.

Pubalgia: Factors involved

• Young males, and particularly males involved in sports.
• About 58% of cases are related to soccer.
• Includes sports-related overload.
• Repetitive movements.
• Postural imbalances.
• Muscular imbalances.
• Dysplasia or micro-traumatisms.
• About 70% of cases involve adductor muscles.

Pubalgia: Body chart

• Localised to the pubic region.

Pubalgia: 24h behavior

• Localized pain; worse with palpation; Possible irradiation.
• Symptoms increase after exercise.
• Symptoms do not worsen with increased intra-abdominal pressure.
• Improves with ice, rest and NSAIDs.
• Symptoms may recur.

Pubalgia: History

• Insidious onset.
• Pain improvement with rest and non-steroidal anti-inflammatory drugs (NSAIDs).
• Possible fissure, or gracile disinsertion.
• Chronic phase: constant pain and limitations.
• Joint overuse may cause micro-traumas.
• Swelling caused by oedema and muscular contractions.

Pubalgia: Special Questions

• Lumbar: radiculopathy, canal stenosis, disc herniation.
• Hip pathology.
• Inguinal hernia.
• Muscle rupture.
• Urinary tract infections.
• Adductor tendinopathy.

Knee: Clinical processes

• Osteoarthritis.
• Patellar tendinopathy.
• Iliotibial band syndrome.
• Patellofemoral pain syndrome.

Knee Osteoarthritis

• A degenerative joint condition characterized by progressive loss of cartilage and marginal bone hypertrophy.
• Changes within the synovial membrane occur.
• Worldwide incidence is estimated to be 240 per 100,000 persons per year.
• OA frequently affects the knee joint and is the most common cause of disability in individuals over 65 years of age (up to 10% of affected individuals).
• It does not affect the entire knee, but typically one or two of the knee compartments.

Knee OA diagnostic criteria

• Criteria are based on clinical records, laboratory testing, and imaging evaluation.
• Clinical records include data such as: pain (gonalgia), age (>50), stiffness (<50 minutes), crepitus, tenderness of the bone; no temperature increases, but bone volume increase is seen.
• Laboratory testing includes: VHS (<40 mm/h), rheumatoid factor (<1:40).
• Imaging evaluation includes osteophytes (bony outgrowths)

Knee OA Classification

• Primary (or idiopathic): 70% of cases in the world.
• Secondary – related to past injuries, inflammations, etc.

Knee OA: factors involved

• Age (around 50 years old).
• Sex (female).
• Genetic component is less prominent than other factors.
• Weight alterations.
• Systemic factors (metabolic syndrome).
• Physical activity – is not considered a direct risk factor for developing this condition..
• Symptoms do not always correlate with radiological alterations in 50% of individuals.

Knee OA: 24-hour behavior

• Typical initial symptoms include mild pain following strenuous activity.
• Pain which worsens when walking up or down stairs or ramps, or during squatting.
• Over time in advanced cases there can be stiffness, instability and swelling (due to effusion) resulting in limited mobility and even deformity.

Knee OS: Actual and past history

• Previous joint injuries (especially those occurring 10-15 years ago)
• Meniscus problems, ACL tears.
• Weight alterations, overuse, local trauma, infections, metabolic disorders

Knee OA: Special questions

• Consider differential diagnoses of other rheumatic or musculoskeletal conditions, including: osteoarthritis (osteoarthrosis, rheumatoid arthritis, fibromyalgia, gout, lupus, psoriatic arthritis, Reiter’s disease, Sjogren's disease).

Patellar tendinopathy

• Overuse injury within the patella tendon, usually accompanied by pain, thickening, and reduced functioning.
• Pain is frequently insidious at onset and is triggered by increased physical activity.
• Pain becomes more persistent with increasing frequency and intensity of exercise.
• Tendinosis is usually more common in impact athletes, with an incidence of 30-45% in this population.
• However, non athletes can also be affected between 8% and 50% depending on working activity
• Several classification methods are used to assess the severity of the injury.

Patellar tendinopathy: Factors involved

• Men aged 35 or older.
• Biomechanical risk factors (including excessive foot pronation, high hip anteversion, increased Q-angle).
• Previous tendon or knee injuries.
• Genetic factors affecting tendon development and healing.
• Incorrect training methods.
• Environmental factors can contribute.

Iliotibial band syndrome

• Runners' knee syndrome.
• Acute external knee pain, generally associated with repetitive knee flexion and extension.
• Iliotibial band (ITB) friction against lateral femoral condyle a common source of pain.
• An increased frequency exists in runners (1.6–12%) and cyclists (15–24%).
• ITB is a source of up to 22% of lower limb related injuries.

Iliotibial band syndrome: Factors involved

• Narrow or wide iliotibial bands which results in friction with the lateral femoral condyle.
• Iliotibial band compression on underlying adipose tissue.
• Weak hip abductors (gluteus medius).
• Poor foot biomechanics (resulting in dysmetria), excessive running and athletic endurance training.
• Clothing can also be contributing factor.

Patellofemoral pain syndrome

• A common cause of dull pain around and front of the knee in the anterior aspect of the knee.
• Patella tracking dysfunction can result in pain.
• Patella never fully makes contact with the femur in all positions.
• Cartilage degeneration and inflammation can result in secondary osteoarthritis.
• There can be a biomechanical component which is dependent on issues with femoral anteversion, Q-angle, genu valgus/recurvatum or tibial varus/pronation of foot.
• Possible muscular weakness in hip external abductors or knee extensors causes muscular problems that can create instability.
• Occurs frequently in females between 40 and 50 years old.
• The incidence is about 18% in men and sports men, and 33% in sportswomen.
• 70% of those with patellofemoral pain over 40 years old have comorbid osteoarthritis.

Patellofemoral pain syndrome: Factors involved

• Age, particularly young adults and adolescents.
• Gender, with females being more likely to be affected.
• Overweight and obesity.
• Reduced flexibility.
• Lack of a good pre-exercise warm-up routine that prepares body for sports activity.
• High level of sporting activity and/or training.

Hip osteoarthritis (OA)

• A degenerative joint disease of the hip joint where cartilage and subchondral bone degrades.
• The hip and subchondral bone thicken, with development of osteophytes.
• Chronic synovitis is commonly present.
• The causes are often multifactorial: wear and tear arthritis, infection, crystal deposition, and/ or autoimmune disorders..
• The condition is often found in individuals over 50 years old, with higher incidence in women and significant association with obesity.

Hip OA: Factors involved

• Advanced age – the likelihood of developing this condition increases in individuals 50 years or older.
• Increasing prevalence with age into 75+ age category.
• Female gender.
• Obesity and other weight-related issues.
• Genetic predisposition.
• Previous joint injury/inflammation.
• Repeated stress applied to the hip joint .
• Muscle weakness.

Hip abductor-rotator tendinosis

• Pain in hip abductor-rotator tendons. Pain often felt around greater trochanter.
• Pain may be felt during or after exercise, or even with prolonged periods of standing or sitting.

Tendinosis or tendonitis?

• Tendinosis – is a degenerative condition resulting from imbalance between tendon tissue damage and self-repair.
• Resulting in compression, friction, and degeneration of the tendon structure.
• Tendonitis – is a common overuse injury that involves inflammatory damage.
• Both can occur simultaneously.

Hip abductor-rotator tendinosis: Special questions

• Localised trauma to the region
• Sports practices, footwear.
• Type of job performed.
• Metabolic dysfunctions.
• Physical conditions including past injuries are relevant..

Test your knowledge on the key characteristics and demographics of ankylosing spondylitis. This quiz covers spinal X-ray findings, the significance of the HLA-B27 gene, and axial symptoms related to this condition. Perfect for students and healthcare professionals alike!