Ankylosing Spondylitis: Introduction FeedbackA general introduction to Ankylosing Spondylitis.Source: Clinical Knowledge Summaries, 01 Feb 2013
Ankylosing spondylitis is a chronic inflammatory rheumatic disease of unknown cause and varying clinical presentation. The principal features (not all of which are present at onset, or in all people) are:
Inflammatory low back pain, (pain and stiffness worse at night and in the morning).
Inflammation of the spinal joints and the junction (enthesis) of the intervertebral spinal ligaments and vertebrae, leading (after many years) to ankylosis (i.e. fusion from fibrosis and calcification).
Inflammation of the sacroiliac joints (on X-ray or other radiological imaging such as MRI), which presents as alternating buttock pain.
Enthesitis (inflammation of the sites where tendons and ligaments attach to bone), costochondritis (inflammation where cartilage joins the ribs), and epicondylitis (inflammation of an epicondyle of bone).
Arthritis of peripheral joints, usually involving the large joints of the lower limbs, or asymmetric arthritis of peripheral joints.
Insidious onset (over a period of at least 3 months, and often several years) usually beginning in late adolescence or early adulthood.
Association with the human leukocyte antigen B27 (HLA-B27).
Ankylosing spondylitis is not uncommon:
About 2% of people in a general practice will present with back pain and up to 5% of these will show features of ankylosing spondylitis.
It is about three times more common in men than women.
It most commonly begins between 20 and 30 years of age, but also occurs in children and older adults.
Common complications include:
Progressive involvement of the lumbar, thoracic, and cervical spine, leading to a fixed and flexed posture.
Damage to peripheral joints.
Anterior uveitis (iritis).
If ankylosing spondylitis is suspected:
The presence of inflammation should be confirmed with erythrocyte sedimentation rate (ESR), and/or C-reactive protein (CRP), and full blood count (FBC) tests.
Local referral protocols should be followed on imaging the sacroiliac joints and spine, or specialist advice sought on imaging before referral. In well-established cases, radiographs of the sacroiliac joints and spine are diagnostic. Magnetic resonance imaging can detect early changes in sacroiliac joints. Ultrasound scanning can confirm a clinical impression of enthesitis.
Referral to a rheumatologist should be arranged.
Treatment should be started with a nonsteroidal anti-inflammatory drug (NSAID).
Treatments available from rheumatologists for ankylosing spondylitis include:
For sacroiliitis: injection of corticosteroids.
For enthesitis (inflammation where bone joins tendon or ligament): injection of corticosteroids.
For uncontrolled disease in general: tumour necrosis factor (TNF)-alpha inhibitors such as etanercept and adalimumab or oral or intravenous bisphosphonates.
Ankylosing Spondylitis: Guidance FeedbackThe most relevant search results for Ankylosing Spondylitis from producers of guidance information.
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Ankylosing Spondylitis: Information for the public FeedbackThe most relevant search results for Ankylosing Spondylitis, from Department of Health accredited producers of patient information.
Ankylosing Spondylitis: Ongoing Research FeedbackThe most relevant search results for Ankylosing Spondylitis, from research trials.
Examination of Radiographic Progression, Efficacy and Safety of Long-Term Treatment With Infliximab in Patients With Ankylosing SpondylitisUK Clinical Trials Gateway, 10 October 2005
16-week Efficacy and 3-year Safety, Tolerability and Efficacy of Secukinumab in Active Ankylosing Spondylitis PatientsUK Clinical Trials Gateway, 08 December 2013
16 Week Efficacy and 5 Year Long Term Efficacy, Safety and Tolerability of Secukinumab in Patients With Active Ankylosing SpondylitisUK Clinical Trials Gateway, 20 July 2012
- UK Clinical Trials Gateway, 29 January 2010
- UK Clinical Trials Gateway, 23 May 2013
Assessment of SpondyloArthritis Society (ASAS) Classification and Diagnostic Criteria for Early Axial Spondyloarthritis (SpA)UK Clinical Trials Gateway, 18 May 2006
Ankylosing Spondylitis: Evidence Uncertainty FeedbackThe most relevant search results for Ankylosing Spondylitis, highlighting areas where further research is needed.
Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidityUK Database of Uncertainties about the Effects of Treatments, 26 January 2012
Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis)UK Database of Uncertainties about the Effects of Treatments, 17 February 2014
- UK Database of Uncertainties about the Effects of Treatments, 04 March 2013
- UK Database of Uncertainties about the Effects of Treatments, 07 April 2010
Combination therapy for pain management in inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)UK Database of Uncertainties about the Effects of Treatments, 14 November 2011
Safety of non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people receiving methotrexate for inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)UK Database of Uncertainties about the Effects of Treatments, 30 November 2011
- UK Database of Uncertainties about the Effects of Treatments, 01 April 2009
Ankylosing Spondylitis: Medicines FeedbackAppropriate medicines information for Ankylosing Spondylitis supplied by Datapharm, a leading source of trusted, credible information about medicines.
Ankylosing spondylitis - Medicines Information
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...Clinical Topic A-Z Clinical Speciality Ankylosing spondylitis Ankylosing spondylitis D013167Spondylitis, Ankylosing Musculoskeletal...02-01Last revised in February 2013 Ankylosing spondylitis - Summary Ankylosing spondylitis is...
Clinical Knowledge Summaries, 01 February 2013
...article Methotrexate for ankylosing spondylitis Junmin Chen 1...Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic...Description of the condition Ankylosing spondylitis (AS) is a type of arthritis...
Cochrane Database of Systematic Reviews, 28 February 2013 - Publisher: John Wiley & Sons, Ltd
...adults with severe active ankylosing spondylitis only if all of the following...criteria for diagnosis of ankylosing spondylitis. There is confirmation...least 4 units on the Bath Ankylosing Spondylitis Disease Activity Index...
National Institute for Health and Care Excellence, 01 May 2008
...content Sulfasalazine for ankylosing spondylitis Junmin Chen 1...Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic...interest Index terms Ankylosing spondylitis (AS) is a chronic inflammatory...
Cochrane Database of Systematic Reviews, 20 April 2005 - Publisher: John Wiley & Sons, Ltd
...Physiotherapy interventions for ankylosing spondylitis Hanne Dagfinrud 1...Physiotherapy interventions for ankylosing spondylitis. Cochrane Database of Systematic...support Index terms Ankylosing spondylitis (AS) is a chronic, progressive...
Cochrane Database of Systematic Reviews, 23 January 2008 - Publisher: John Wiley & Sons, Ltd
...treatment of severe, active ankylosing spondylitis in adults only if: it...etanercept and infliximab for ankylosing spondylitis' (NICE technology appraisal...treatment of severe, active ankylosing spondylitis who do not fulfil the criteria...
National Institute for Health and Care Excellence, 01 August 2011
Indirect comparison of the effects of anti-TNF biological agents in patients with ankylosing spondylitis by means of a mixed treatment comparison performed on efficacy data from published randomised, controlled trials
...agents in patients with ankylosing spondylitis by means of a mixed treatment...arthritis of the spinal joints (ankylosing spondylitis). The paucity of evidence...arthritis of the spinal joints (ankylosing spondylitis). Searching MEDLINE...
Database of Abstracts of Reviews of Effects, 13 November 2012
Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation
...infliximab for the treatment of ankylosing spondylitis: a systematic review and...therapy for patients with ankylosing spondylitis, concluded that the therapy...infliximab) for the treatment of ankylosing spondylitis. This abstract will only...
Database of Abstracts of Reviews of Effects, 01 December 2008
...rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis...rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis...rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis...
Cochrane Database of Systematic Reviews, 05 October 2011 - Publisher: John Wiley & Sons, Ltd
...rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis...rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis...including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and...
Cochrane Database of Systematic Reviews, 09 November 2011 - Publisher: John Wiley & Sons, Ltd
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