Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the spine and sacroiliac joints, leading to progressive stiffness, pain, and fusion of the vertebrae (bamboo spine).
Mnemonic: "A.N.K.Y.L.O.S.I.S. = Arthritis Narrowing Kyphosis
Your Lumbar On Spine Inflammation Stiffness"
CAUSES & RISK FACTORS
- Autoimmune Disorder (HLA-B27 Gene Association).
- Male Predominance (3:1 Male: Female Ratio).
- Onset in Young Adults (Peak in 2nd–3rd Decade).
- No Identified Infectious Cause, But Gut Microbiome (Klebsiella) May Play a Role.
Mnemonic: "H.A.M.O." (HLA-B27, Autoimmune, Male, Onset in
20s-30s)
SYMPTOMS OF ANKYLOSING
SPONDYLITIS
- Chronic Low Back Pain (Worse in Morning, Improves with Movement).
- Pain & Stiffness in the Spine, Sacroiliac Joints, and Hips.
- Progressive Loss of Spinal Mobility → "Bamboo Spine".
- Chest Expansion Reduced (Costovertebral Joint Involvement).
- Fatigue Due to Chronic Inflammation.
Mnemonic: "S.T.I.F.F." (Stiffness, Thoracic Pain,
Immobility, Fatigue, Fusion of Spine)
EXTRA-SPINAL FEATURES
- Eye → Anterior Uveitis (Pain, Redness, Blurred Vision).
- Heart → Aortic & Mitral Valve Involvement, Conduction Defects.
- Lungs → Upper Lobe Fibrosis.
- GI → Associated with IBD (Crohn’s, Ulcerative Colitis).
- Joints → Asymmetrical Arthritis (Hips, Knees, Shoulders).
- Enthesitis (Inflammation of Ligament & Tendon Insertions, e.g., Achilles Tendon).
Mnemonic: "E.H.L.G.J.E." (Eye, Heart, Lungs, Gut, Joints,
Enthesitis)
CLINICAL EXAMINATION
- Schober’s Test → Limited Lumbar Spine Flexion (<5 cm Expansion Abnormal).
- Occiput-to-Wall Distance → Measures Cervical Spine Involvement.
- Chest Expansion Test → Reduced Expansion <2.5 cm.
Mnemonic: "S.O.C." (Schober, Occiput, Chest Expansion
Test)
INVESTIGATIONS
Blood Tests:
- ↑ ESR, ↑
CRP (Inflammation Markers).
- HLA-B27
Positive (In 90% of AS Patients).
- Rheumatoid
Factor (RF) Negative (Seronegative Arthritis).
X-ray Findings:
- Sacroiliitis
(Earliest Sign – Joint Erosion, Sclerosis, Fusion).
- Bamboo
Spine (Late Stage – Vertebral Fusion).
- Syndesmophytes
(Thin Bony Growths Between Vertebrae).
MRI (Best for Early Diagnosis – Detects Sacroiliitis Before X-ray
Changes).
Mnemonic: "E.H.R.X.M." (ESR, HLA-B27, Rheumatoid Factor
Negative, X-ray, MRI)
TREATMENT OF ANKYLOSING
SPONDYLITIS
1. LIFESTYLE & PHYSICAL
THERAPY
- Daily Exercise & Postural Training (Swimming Is Ideal).
- Avoid Prolonged Inactivity (Frequent Breaks in Desk Jobs).
- Good Sleep Position (Firm Mattress, No Pillow).
Mnemonic: "E.A.G." (Exercise, Avoid Inactivity, Good
Sleep Posture)
2. MEDICAL MANAGEMENT
- NSAIDs (First-Line – Indomethacin, Naproxen, Diclofenac).
- DMARDs (For Peripheral Arthritis – Sulfasalazine, Methotrexate).
- Biologics (TNF-α Inhibitors – Etanercept, Infliximab, Adalimumab).
Mnemonic: "N.D.B." (NSAIDs, DMARDs, Biologics for Severe
Cases)
3. SURGICAL MANAGEMENT (For
Severe Deformity)
- Total Hip Replacement (If Hip Joints Are Severely Affected).
- Spinal Osteotomy (For Severe Kyphosis & Deformity).
Mnemonic: "H.S." (Hip Replacement, Spinal Osteotomy)
HOMOEOPATHIC MANAGEMENT OF
ANKYLOSING SPONDYLITIS
For Chronic Back Stiffness & Pain:
Rhus Tox, Bryonia, Arnica, Calcarea Fluor.
For Severe Morning Stiffness & Fatigue:
Kali Carb, Causticum, Dulcamara.
For Joint & Tendon Inflammation:
Ruta, Symphytum, Actaea Spicata.
For Autoimmune & Seronegative Arthritis:
Thuja, Medorrhinum, Psorinum.
Mnemonic: "R.B.A.C. – Rhus Tox, Bryonia, Arnica, Calc Fluor
for Stiffness & Pain"
FINAL REVISION WITH MNEMONICS
- Definition = "A.N.K.Y.L.O.S.I.S. = Arthritis Narrowing Kyphosis Your Lumbar On Spine Inflammation Stiffness"
- Causes = "H.A.M.O." (HLA-B27, Autoimmune, Male, Onset in 20s-30s)
- Symptoms = "S.T.I.F.F." (Stiffness, Thoracic Pain, Immobility, Fatigue, Fusion of Spine)
- Extra-Spinal = "E.H.L.G.J.E." (Eye, Heart, Lungs, Gut, Joints, Enthesitis)
- Examination = "S.O.C." (Schober, Occiput, Chest Expansion Test)
- Investigations = "E.H.R.X.M." (ESR, HLA-B27, Rheumatoid Factor Negative, X-ray, MRI)
- Lifestyle = "E.A.G." (Exercise, Avoid Inactivity, Good Sleep Posture)
- Medical = "N.D.B." (NSAIDs, DMARDs, Biologics for Severe Cases)
- Surgical = "H.S." (Hip Replacement, Spinal Osteotomy)
- Homeopathy = "R.B.A.C." (Rhus Tox, Bryonia, Arnica, Calc Fluor for Stiffness & Pain)
