Define ankylosing spondylitis

Ankylosing spondylitis (AS) is a seronegative inflammatory arthritis of the spine of unknown etiology. It presents in the early stages with an inflammatory arthritic pain that typically involves the sacroiliac joints initially and later the other spinal regions. The classic feature of AS is enthesopathy (inflammation at the attachments of ligaments, tendons, and joint capsules to bone). Initially, range of motion is normal or mildly limited. Disease progression leads to spinal ossification, osteoporosis, and altered spinal biomechanics. The spine may eventually fuse in a kyphotic position. The lack of spinal flexibility causes the spinal column to be vulnerable to fractures following minor trauma. AS may affect the lumbar, thoracic, and cervical spinal regions. Other skeletal manifestations include dactylitis (sausage-shaped digits), heel pain (Achilles tendon insertion), and hip arthritis. Extraskeletal manifestations occur and involve the eyes (anterior uveitis), as well as cardiac, pulmonary, renal, and neurologic systems Figure 69-1.

Figure 69-1. Ankylosis of the lumbar spine in a patient with ankylosing spondylitis.

A, Anteroposterior radiograph of the lumbar spine demonstrates ossification of the inter-spinous ligament, known as the dagger sign (arrowhead). One can also see ankylosis of the facet joints resulting in the tram track sign (arrows) paralleling the dagger sign.

B, Lateral radiograph of the thoracic spine in the same patient reveals the bamboo spine appearance owing to ossification of the outer fibers of the annulus fibrosus and resultant fusion of the thoracic spine. C, Grade 4 sacroiliitis (using the modified New York criteria) in a patient with ankylosing spondylitis. The radiograph readily demonstrates bilateral ankylosis of the sacroiliac joints. (From Bennett DL, Ohashi K, El-Khoury GY. Spondyloarthropathies: Ankylosing spondylitis and psoriatic arthritis. Radiol Clin North Am 2004;42(1).)

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