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ANKYLOSING SPONDYLITIS-INVESTIGATION

Rheumatology

ANKYLOSING SPONDYLITIS-INVESTIGATION

1. Radiograph changes often occur late ( > 10 years).

2. MRI is more sensitive - shows marrow signal change adjacent to the SI joint.

3. Because of the high sensitivity (> 90%), a negative HLA-B27 test can exclude AS.

4. Ddx: diffuse idiopathic skeletal hyperostosis (DISH).

5. DISH X-ray findings  include "flowing" osteophytes due to calcification of the ALL predominantly in the thoracic region (unlike lumbar spine in AS).

6. DISH is an incidental finding, affects men > 50yrs, rarely symptomatic, does not involve the SI joints and not A/W HLA-B27 or raised ESR/CRP


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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