Contents
Ankylosing spondylitis is suspected of:
-
Disease history
- "Inflammatory back pain(Gradual onset before 40-45 years of age, duration at least 3 months, better physical activity, nocturnal pain)
- Family disposition (First row family = parents, siblings, children)
- Known HLA-B27 +
- Ankylosing spondylitis?
- Eye manifestations (Uveitis / Iridocyclitis)
- Peripheral arthritis (hips / knees)
- Tendinitis (entesitis)
- Achilles tendon
- Plantar facie
- Psoriasis (disposable factor for axial psoriasis arthritis)
- Extensor side of elbows and knees
- Hairline and scalp
- At navel and anus
- Nails
- Inflammatory bowel disease (Ulcerative colitis / Crohn's disease) is disposable (Blood and mucus in stools, abdominal pain)
- Heart or lung disease
-
Clinical examination
- Posture
- Increased thoracic kyphosis
- Flattened lumbar lordose
- Flexed (bent) hip joint
- Movement (all three planes: extension, flexion, lateral flexion) in the neck (cervical colum), thoracic column (thoracic columnar, thoracic excursion less than 2,5cm in 4. Intercostal space) and lumbar (lumbar columnar)
- Distance between the head (occiput) and a wall when standing as close to the wall as possible with the entire back
- Schober's test of the lower back
- Finger-floor distance by forward bending
- The circumference of the thorax at maximum in and out (thoracic excursion)
- Arthritis of knees, Baker's cyst in knee hase (popliteal)
- Movement of the hips
- Hip-arthritis (reduced internal rotation)
- Pain during provocation tests against iliosacral joints
- Achilles tendons and plantar facies (entesopathy)
- Eyes: Uveitis-sequelae
- Auscultation of the heart (heart rhythm disorders, aortic valve insufficiency)
- Urine: proteinuria by AA-amyloidosis (Secondary due to prolonged illness)
- Posture
-
Radiological examinations
- MRI or CT of sacroiliac joints
- X-ray or MRI examination of thoracic-lumbar transition
- Incipient ankylosis or signs of inflammation?
-
Blood tests
- CRP elevated in most cases
- HLA B27 + (genetic factor) exists in excess of 95% (8-10% of normal Norwegian population)
The referral
- In Oslo there is a distribution of functions within rheumatology. Patients with Ankylosing spondylitis should be referred Diakonhjemmet hospital, whereas connective tissue and systemic vasculitis will be assessed at Oslo University Hospital, Rikshospitalet
- Norwegian Directorate of Health (Supervisor for referrals)
Bekhterev's disease, BINDEVEVSSYKDOMMER.no
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