ANKYLOSING SPONDYLITIS-1.pptx

Ankylosing Spondylitis..ANKYLOSING SPONDYLITIS
Also known as Axial Spondylitis.
INTRODUCTION
Ankylosing Spondylitis : Greek word

Ankylos- Bent- Stiffness – Fusion
Spondylitis- Inflammation of the spinal Vertebrae.

Spondylos- Vertebrae
Itis - Inflammation

Defination
Ankylosing Spondylitis is a type of Arthritis that causes inflammation in the joint and ligament of the spine.

It also may affect Peripheral joints such as knees, ankle, hips.



Over time the inflammation in the joints and tissue of the spine can causes back pain, stiffness leading into Rigid and inflexible spine.

In severe cases, the bones in
the spine fuses together completely
resulting in a long Bony coloumn
also known as Bamboo Spine.


PREVALENCE…
Peak age of onset is 15to 35 yrs.

Prevalence varies between 0.1% and 2% in different population.

The male : female ratio is around 5:1
Causes of ankylosing spondylitis
It has no known specific causes, but both genetics and environment factors seems to be involved .

Genetics-Human Leukocytes Antigen HLA-B27

Environmental Factors- Infections, Toxins, Pollutants, Injury to affected joints, Changes in bacteria in your colon and Bowel inflammations.

Signs and symptoms…
They usually began in late Adolescence or early adulthood and may include:-

Neck pain and stiffness.

Arthritis in the hip and shoulder.

Low Back pain and stiffness in the morning which wears off during the day or with activity.
Others symptoms…
Chest pain or Tightness.

Swollen fingers or toes.

Tenderness in heels.

Eyes Inflammation (Uveitis)

Pain and swelling in joints
other then those in the spine.







diagonosis
History And Physical Examinations
Imaging Test [X-ray & MRI ]
Blood Tests And Laboratory tests.
History of Pain and stiffness
Morning stiffness that last for more than 30 min of duration.
Whether symptoms relieve on activity or worsen with inactivity.
Awakening because of the back pain during the second part of night.
If the patient experience alternative buttocks pain.
Family History.
Physical examinations…
A Physical Examination may include the following :-
Joint Examinations- Assessing the Range of Motion along the joints and the stiffness.
Checking the Flexibility [Schober’s Test]
Chest Expansion Test.
Lumbar Mobility tests…
Finger to Floor Distance Test
Lumbar Lateral Flexion Distance Test
Schober’s test
The examiner make mark at the level of L5.
The examiner then places one finger 5cm below this mark, and another, second ,finger 10cm above mark.
The patient is asked to touch his toes.
By doing so, the dstance between the two fingers of the examiner increases.
However the restriction in the Lumber Flexion of the patient reduces this distances.
If the distance increases less than 5cm then there is an indication is that the flexion of lower back is limited.

Checking flexibility
It involves watching how he move and bend in different directions.

A tape is used to measure flexion and extension of the lumbar spine.

1. ANKYLOSING SPONDYLITIS Also known as Axial Spondylitis.

2. INTRODUCTION Ankylosing Spondylitis : Greek word Ankylos - Bent- Stiffness – Fusion Spondylitis- Inflammation of the spinal Vertebrae. Spondylos - Vertebrae Itis - Inflammation

3. Defination Ankylosing Spondylitis is a type of Arthritis that causes inflammation in the joint and ligament of the spine. It also may affect Peripheral joints such as knees, ankle, hips.

4. Over time the inflammation in the joints and tissue of the spine can causes back pain, stiffness leading into Rigid and inflexible spine. In severe cases, the bones in the spine fuses together completely resulting in a long Bony coloumn also known as Bamboo Spine .

5. PREVALENCE… Peak age of onset is 15to 35 yrs. Prevalence varies between 0.1% and 2% in different population. The male : female ratio is around 5:1

6. Causes of ankylosing spondylitis It has no known specific causes, but both genetics and environment factors seems to be involved . Genetics-Human Leukocytes Antigen HLA-B27 Environmental Factors- Infections, Toxins, Pollutants, Injury to affected joints, Changes in bacteria in your colon and Bowel inflammations.

7. Signs and symptoms… They usually began in late Adolescence or early adulthood and may include:- Neck pain and stiffness. Arthritis in the hip and shoulder. Low Back pain and stiffness in the morning which wears off during the day or with activity.

8. Others symptoms… Chest pain or Tightness. Swollen fingers or toes. Tenderness in heels. Eyes Inflammation (Uveitis) Pain and swelling in joints other then those in the spine.

9. diagonosis History And Physical Examinations Imaging Test [X-ray & MRI ] Blood Tests And Laboratory tests.

10. History of Pain and stiffness Morning stiffness that last for more than 30 min of duration. Whether symptoms relieve on activity or worsen with inactivity. Awakening because of the back pain during the second part of night. If the patient experience alternative buttocks pain. Family History.

11. Physical examinations… A Physical Examination may include the following :- Joint Examinations- Assessing the Range of Motion along the joints and the stiffness. Checking the Flexibility [ Schober’s Test] Chest Expansion Test.

12. Lumbar Mobility tests… Finger to Floor Distance Test Lumbar Lateral Flexion Distance Test

13. Schober’s test The examiner make mark at the level of L5. The examiner then places one finger 5cm below this mark, and another, second ,finger 10cm above mark. The patient is asked to touch his toes. By doing so, the dstance between the two fingers of the examiner increases. However the restriction in the Lumber Flexion of the patient reduces this distances. If the distance increases less than 5cm then there is an indication is that the flexion of lower back is limited.

14. Checking flexibility It involves watching how he move and bend in different directions. A tape is used to measure flexion and extension of the lumbar spine. Limited motion in lower back is Symptomatic of Ankylosing Spondylitis. The test is also known as modified Schober’s Test.

15. Cervical Mobility tests….. Occiput-to-Wall Distance Flesche Test Tragus-to-Wall Distance Yest

16. Test for Sacroilitis Pelvic Compression Test Gaenslen Test

17. Range of Motion… Cervical Spine Thoraco Lumbar Spine Forward Flexion- to 45 degree. Extension- to 45 degree . Lateral Flexion- to 45 degree . Lateral Rotation- to 80 degree. Forward Flexion- to 90 degree . Extension- to 30 degree . Lateral Flexion- to 30 degree . Lateral Rotation- to 30 degree.

18. Chest expansion… Chest expansion is measured by placing a tape around the circumference of the chest wall at the fourth intercostal space. Decreased Chest Expansion relative to normal value for age and sex could indicate Ankylosing Spondylitis.

19. Chest expansion measurement…

20. Blood tests…. The patients may have to undergo one or more of these blood tests:- Erythrocyte Sedimentation Rate [ESR]. Elevate C-reactive Protein [CRP]. HLA-B27 marker in Blood. However, These tests have limited value in determining disease activity.

21. Imaging test…. X-ray:- Helps to monitor disease progression and joint damage . However it may take years before the changes can be seen on X-ray. MRI:- Helpful in early diagnosis of the disease as it produced signals to create images for their better analyzation of the joint.

22. Imaging test…

23. Complications of Ankylosing spondylitis… Eye Inflammation. Scarring and thickening of Lung tissue. Colitis or inflammation in the large intestine. Inability to control urination. Psoriasis [A skin disorder]. The absence of normal reflexes in then ankles. Low Bone density [Osteoporosis].

24. Treatment goals of Ankylosing Spondylitis:- The main goal of treatment is to maximize the quality of life. Alleviation of pain. Retaining and recovery of physical functions. Delay of structural damage responsible for Physical impairment.

25. Treatment options… Drug treatment. Non Drug Treatment i.e Physiotherapy. Surgical Procedures.

26. Drugs treament .. NSAIDs:- Aspirin, Ibuprofen Analgesic:- Acetaminophen Corticoticoseroids :- Decrease inflammation and provide pain relief. Usually given as an injection into the joint. Conventional Disease modifying Anti Rheumatic Drugs [CMARDs]:- Not recommended for back pain. Considered for treating Peripheral Joints. Sulfasalazine. Biological Modifications:- TNF- α inhibitors .

27. Non drugs treatment or physiotherapy Physiotherapy includes:- Pain Management Regular Exercise Massage Therapy Patient Educations

28. Pain management… TENS UST IFT Hot packs , Hot Shower Bath Exercises

29. Exercises… According to the American College of Sports Medicine [ACDSM] recommendation exercise in general are classified into 4 core categories:- Muscle Strengthening or Resistance Exercises. Aerobic Exercises. Flexibility Or Stretching Exercises. Neuromotor Skills Training. -Balance and Cordinations .

30. WHO:- recommends every adult should accumulate atleast 150min of moderate intensity Aerobic physical activity through out the week or atleast 75min of Vigrous intensity Aerobic exercise along with muscles strengthening Exercises.

31. Rehabilitation Program… Intervention to reduce pain using Electrotherapy Modalities. Intervention to improve flexibility and spinal mobility 10-15min to be practiced as a daily basis. -Stretching of the body muscles. -Yoga - Gymanastic Ball -Sitting Crossed Legged

32. Intervention to improve the muscle strength. Muscles Strengthening Ex’s for Cervical Spine, DorsoLumbar Spine, Shoulder, Hip, Knee, Abdominal Muscles, Thoracic Rotators. - Free weights -Machines - Thera bands -Core Stability Ex’s Balancing training on a regular basis: -One Leg Stances -Stability Ball -Strengthening Core Muscles . etc

33. Stretching Ex’s… Press Up to Stretch Your Spine. Plank for a Stronger Core. Try Standing Leg Raises to Loosen Tight Hips. Do Chin Tucks to Stretch Your Neck. Roll Your Shoulders to Loosen Up. Stretch Your Hips to Ease Low Back Pain Corner Stretch to Open Your Chest Walk, Move. Take Deep Breaths. Every exercise should be done 10 to 15 repetition holding at least 5-10sec.

34. Surgery… Aims at alleviating pain and improving mobility. Required in cases when joints are badly affected. The knee and hip are the joints most often replaced. The procedure is often done by an experienced surgeons.

35. Behavioural and lifestyle recommendations for patients:- General - Maintain a proper posture at work, at leisure and when sleeping. - Avoid overtiring yourself. - Avoid becoming overweight. - Avoid Smoking. - Maintain a Good attitude. - Ergonomics.

36. Do’s & Don’ts Routine checkup and Ex’s. Follow the treatment Plan. Stay Active with regular exercise. Maintain healthy diet. Practice good posture. Don’t smoke.