Symptoms associated with ankylosing spondylitis
(AS) may be divided into 2 categories: those that are articular in
nature and those that are extra-articular in nature. The information
that follows is a summary of many, but not all, clinical abnormalities
associated with AS.
The main musculoskeletal features associated
with AS are traditionally sacroiliitis, enthesitis, and synovitis.
For many AS patients, the symptoms may first appear in late adolescence
or even early adulthood (in western countries, median age 23 years).
It is rare (approximately 5%) for symptoms to begin after the age
of 40.11500 Sacroiliitis is considered a key clinical
hallmark regarding the diagnosis of AS. Sacroiliitis occurs most commonly
in late adolescence or in the 30s. It results in either bilateral
(more frequently) or unilateral (less frequently) buttock pain with
pain worsening after inactivity or weight-bearing activities.11477 Enthesitis is regarded as one of the hallmark features of
AS, based primarily on the findings of two advanced AS cases from
the 1970s.11452 Enthesitis is an inflammation of the entheses
(found in both the axial and appendicular skeleton) which are locations
of attachment for tendon, ligament, fascia, or joint capsule to the
bone.11501 Synovitis
may be caused by the distribution of joints, as compared to histological
changes, and may be similar to other forms of rheumatic conditions.
Synovitis often does not follow a timetable as it may appear before,
with, or after spinal symptoms. The upper limbs are usually not involved.
The hips, knees, ankles, and metatarsophalangeal joints are often
areas of main involvement. In comparison to rheumatoid arthritis,
synovitis may be oligoarticular, asymmetrical, and possibly episodic.11477 Additional information can be found in Signs and Symptoms of Ankylosing Spondylitis.
Extra-articular complications can include: inflammatory
bowel manifestations, cardiac conditions, ocular manifestations (such
as uveitis), and osteopenia and osteoporosis (prevalence of osteoporosis
in AS varies greatly from 18.7% - 62%).11515 AS is strongly associated with colonic inflammation, even
in the absence of a formal diagnosis of inflammatory bowel disease,
with 60% of AS patients demonstrating inflammation on ileocolonoscopy.2131 According
to several studies, extra-articular manifestations that involve the
eye occurred in approximately 25% of AS cases.11453 According to several studies, cardiac conditions, such as
aortic regurgitation, atrioventricular or bundle branch blocks, and
mitral regurgitation (less frequently), may occur in about 5% of AS
cases, with a majority of the patients being human leukocyte antigen
(HLA)-B27 positive. These results seem to indicate aortic root disease
and conduction irregularities may be linked to HLA-B27.11453 Additional information can be found in Extra-articular Manifestations in Ankylosing Spondylitis.
Content on this page was last reviewed
on
January 01, 2010.
Content on this page was last changed on
March 27, 2009.
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