Bechterews disease also known as
Correct Answer: Ankylosing spondylitis
Description: Ans. is 'b' i.e., Ankylosing spondylitis ANKYLOSING SPONDYLITIS (MARIE - STRUMPELL DISEASE) Ankylosing spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton. Prototype of seronegative (absence of rheumatoid factor) spondyloahropathies. Inflammatory disorder of unknown cause. Usually begins in the second or third decade with a median age of 23, in 5% symptoms begin after 40. o Male to female ratio is 2-3 : 1 Strong correlation with HLA-B27 90-95% of cases are positive for HLA B27. Joints involved in ankvlosing spondylitis Ankylosing spondylitis primarily affects axial skeleton. The disease usually begins in the sacro-iliac joints and usually extends upwards to involve the lumbar, thoracic, and often cervical spine. In the worst cases the hips or shoulders are also affected. Hip joint is the most commonly affected peripheral joint. o Rarely knee (Ebenzar 4thie 593) and ankle (Apley's 9th/e 67) are also involved. Clinical features Low back pain of insidious onset Duration usually less than 3 months Significant morning stiffness and improvement with exercise o Limited chest expansion Diffuse tenderness over the spine and sacroiliac joints Loss of lumbar lordosis, increased thoracic kyphosis Decreased spinal movements (especially extension) in all directions. Radiological features of ankvlosing spondvlitis Radiographic evidence of sacroiliac joint is the most consistent finding in ankylosing spondylitis and is crucial for diagnosis. The findings are :? Sclerosis of the aiculating surfaces of SI joints Widening of the sacroiliac joint space Bony ankylosis of the sacroiliac joints Calcification of the sacroiliac ligament and sacro-tuberous ligaments Evidence of enthesopathy - calcification at the attachment of the muscles, tendons and ligaments, paicularly around the pelvis and around the heel. o X-ray of lumbar spine may show :- Squaring of veebrae : The normal anterior concavity of the veebral body is lost because of calcification of the anterior longitudinal ligament. Loss of the lumbar lordosis Bridging `osteophytes' (syndesmophytes) Bamboo spine appearance
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