Ankylosing spondylitis

(A) (HLA B27) (1093 - Davidson 21st)ANKYLOSING SPONDYLITIS JOINTS AND SPINE* Predominating effecting the sacroiliac joints and spine* HLA-B27 positive* Increased facel carriage of Klebsiella aerogens occurs in patients with established as and may relate to exacerbation of both joint and eye disease.* Low back pain and marked stiffness* Symptoms are more marked in the early morning and after inactivity, and are relieved by movement.* Although the lumbosacral area is usually the first and worst affected region.* Planter fasciitis, achilis tendinitis and tenderness over bony prominences. Such as the iliac crest and greater trochanter are common reflecting inflammation at the sites of tendon insertion (Enthesitis or Osteitis)*** The modified Schober test is a useful measure of lumber spine flexion.* Most serious complication of the spinal disease is spinal fracture.* Most common extraarticular manifestation is acute anterior uveitis.EXTRA ARTICULAR FEATURES OF AS* Anterior uveitis and conjunctivitis* Prostatitis usually asymptomatic* Cardiovascular disease> Aortic incompetence> Mitral incompetence> Cardiac conduction defects> Pericarditis* Amyloidosis, psoriasis* Atypical upper lobe pulmonary fibrosis* Retroperitoneal fibrosis* Cauda equina syndromeRadiographic features:* Sacroilitis is often first abnormality.* Earliest changes by standard radiography are blurring of the cortical margins of the subchondral bone.* Anterior "squaring" of vertebrae due to erosion and sclerosis of the anterior comers and periositis of the waist.* "Bamboo Spine" (Bridging the adjacent vertebral bodies).* Osteoporosis and atlanto-axial dislocation can occur as late features.HLA - B 27 is associated with1. Ankylosing spondylitis2. Reiter's syndrome3. Reative arthritis (Yersinia, salmonella, Shigella, Chlamydia)4. Psoriatic spondylitis5. Acute anterior uveitisOther conditions associated with HLA'sHLA B-8 - M. gravisHyperthyroidismDW-4 / DR4- Rheumatoid arthritis P. VulgarisHLA DR 3 - Glutein sensitive enteropathyDiabetes mellitus type IM. gravis chromic active hepatitisHLA - B5 - Bechet's syndromeHLA - DR2 - Narcolepsy, Good pasture's syndrome Multiple selerosis