MSK: Ankylosing Spondylitis: Free MSRA Podcast

🦴 Deep Dive: Ankylosing Spondylitis — Back Pain with a TwistNagging morning stiffness? Young male with chronic back pain? Let’s break down Ankylosing Spondylitis (AS) — a chronic inflammatory spine condition that can lead to vertebral fusion. A high-yield MSK topic for your MSRA revision — simplified, structured, and memorable.🎯 What Is AS?• Chronic inflammation of the spine + sacroiliac joints• Leads to pain, stiffness, and spinal fusion• Associated with HLA-B27• Most common in young men (20–30)📌 Radiographic axSpA = AS (X-ray evidence)📌 Non-radiographic axSpA = MRI changes only🧬 Causes & Risk Factors• HLA-B27 gene• Family history• Male sex• Onset <45 years• GI infections (e.g. Klebsiella)💡 Mnemonic: B27 Backbone — HLA-B27 + spinal inflammation🔬 Pathophysiology• Chronic inflammation ➜ new bone formation ➜ syndesmophytes• Fusion of vertebrae ➜ ↓ flexibility• Extra-articular features: uveitis, enthesitis, heart/lung involvement🩺 Clinical Features• Inflammatory back pain: – Morning stiffness >30 min – Improves with exercise – Worsens with rest• Night pain (2nd half of night)• Fatigue, weight loss• Uveitis, enthesitis (Achilles, plantar fascia), dactylitis💡 Mnemonic: AS Spine FUSEDFatigue, Uveitis, Sacroiliitis, Enthesitis, Dactylitis📋 Differential Diagnosis• Mechanical back pain• Psoriatic arthritis• Reactive arthritis• Spinal TB, tumour• Cauda equina📌 Pain that improves with rest = not AS📊 Epidemiology• Prevalence: 0.5–1% UK• ♂ > ♀ (up to 3:1)• Typical onset: late teens to 30s• High heritability (90% concordance in twins)🧪 Diagnosis – Modified New York Criteria✅ Clinical (≥1):• Chronic back pain >3 months, improved with exercise• Limited lumbar motion• ↓ chest expansion✅ Radiological: Sacroiliitis on X-rayDefinite AS = 1 radiological + 1 clinicalProbable AS = 3 clinical OR radiological alone🧾 Investigations• X-ray pelvis: sacroiliitis• MRI spine: early inflammation• DEXA: osteoporosis• ESR/CRP: may be raised• HLA-B27, FBC (normocytic anaemia), spirometry if ↓ chest expansion💊 Management🎯 Goals:• Reduce pain & stiffness• Maintain mobility• Prevent complications✅ Non-Pharmacological• Daily exercise (stretching, swimming, postural)• Physiotherapy✅ Medications• NSAIDs – 1st line (e.g. naproxen)• Biologics: – TNF-α inhibitors: adalimumab, etanercept – IL-17 inhibitors: secukinumab – JAK inhibitors: upadacitinib (newer option)• Local steroids for enthesitis• PPI if on long-term NSAIDs🦴 Surgery• Hip replacement• Spinal osteotomy in severe kyphosis📉 Prognosis & Complications• Course varies: mild to severe fusion• Complications: – Kyphosis – Restrictive lung disease – Osteoporosis & spinal fractures – Uveitis – ↑ Cardiovascular risk – Cauda equina (rare)💡 Early treatment = better outcomes🧠 MSRA Tips• Think AS in young male with morning stiffness + night pain• Use AS Spine FUSED & B27 Backbone mnemonics• Modified New York Criteria = diagnosis framework• Don’t forget MRI if X-ray is normal📚 MSRA Resources for AS📝 Revision Notes🃏 Flashcards📖 Accordion Q&A Notes🎯 Rapid Quiz🧠 Full Quiz Access🌐 More Help:🔗 www.PassTheMSRA.com🔗 www.FreeMSRA.com#MSRA #AnkylosingSpondylitis #AxSpA #MSRARevision #MSK #PassTheMSRA #FreeMSRA #Rheumatology #HLA-B27 #MorningStiffness #Uveitis #InflammatoryBackPain #MSRAFlashcards #MSRAQuiz