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theories of relation to HLA-B27 include enthesitis disc space involvement Genetics there is a genetic predisposition, but mode of inheritance is unknown HLA-B27 is located on sixth chromosome, B locus bilateral sacroiliitis HLA-B27 positive (90% positive) Systemic manifestations acute anterior uveitis & iritis heart disease (cardiac conduction abnormalities) pulmonary fibrosis renal amyloidosis ascending aortic conditions (aortitis, stenosis, regurgitation) Klebsiella pneumoniae synovitis Orthopaedic manifestations bilateral sacroiliitis progressive spinal kyphotic deformity cervical spine fractures large-joint arthritis (hip and shoulder) Anatomy Enthesis defined as the insertion of tendon, ligaments, or muscle into bone Presentation Symptoms lumbosacral pain and stiffness neck and upper thoracic pain sciatic loss of horizontal gaze shortness of breath Physical exam limitation of chest wall expansion decreased spine motion kyphotic spine deformity hip flexion contracture sacroiliac provocative tests Imaging Radiographs spine pelvis & lower extremity CT will show bony changes but not active inflammation CT is most sensitive test to diagnose cervical fractures in patients with AS MRI will detect inflammation, making it the best modality for early detection of AS in young patients obtain with cervical fractures to look for epidural hemorrhage Bone scan will show inflammation in the sacroiliac joints, but lacks specificity Studies Labs little diagnostic value often see nonspecific elevations in ESR and CRP RF negative (seronegative) Diagnostic Injections SI joint injection Differentials Treatment General Nonoperative NSAIDS, COX-2 inhibitors, and therapy TNF-alpha-blocking agents Operative see below Spine Trauma Introduction epidemiology pathanatomy prognosis Presentation symptoms physical exam Imaging Treatment nonoperative operative Spinal Deformity Introduction usually a kyphotic deformity of upper spine be sure to eliminate hip contractures as reason for deformity Treatment C7-T1 cervicalthoracic osteotomy Large-Joint Arthritis Introduction asymmetric involvement of large joints shoulder and hip most commonly involved Treatment total hip replacement b ilateral total hip arthroplasty Create a free account or log in to see the cards.

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