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{{Ankylosing spondylitis}}
{{Ankylosing spondylitis}}
{{CMG}}
{{CMG}} ; {{AE}} {{MKK}}


==Overview==
==Overview==
A clinical examination and [[X-ray]]s of the spine, which show characteristic spinal changes such as [[Sacroiliac joint|sacroiliitis]], are the major diagnostic tools for ankylosing spondylitis. The findings on an X Ray that are consistent with a diagnosis of akkylosing spondilitis are the presence of subchondral erosions, [[sclerosis]], proliferation on the iliac side of SI joints, and squaring of the vertebral body.
An [[x-ray]] may be helpful in the diagnosis of [[ankylosing spondylitis]] (AS). Findings on an x-ray suggestive of ankylosing spondylitis (AS) include [[Erosion (dental)|erosion]] and [[ankylosis]] of the [[Sacroiliac joint|sacroiliac joints]].


==X Ray==
==X Ray==
[[Image:Morbus Bechterew.jpg|left|thumb|200px|Ankylosing spondylitis (Morbus Bechterew)]]
* A standard [[anteroposterior]] (AP) plain [[x-ray]] of the [[pelvis]] helps in recognizing the AS.
* Indistinct joints
* Findings on an x-ray suggestive of/diagnostic of [[ankylosing spondylitis]](AS) include<ref name="pmid20971774">{{cite journal |vauthors=Jang JH, Ward MM, Rucker AN, Reveille JD, Davis JC, Weisman MH, Learch TJ |title=Ankylosing spondylitis: patterns of radiographic involvement--a re-examination of accepted principles in a cohort of 769 patients |journal=Radiology |volume=258 |issue=1 |pages=192–8 |date=January 2011 |pmid=20971774 |pmc=3009382 |doi=10.1148/radiol.10100426 |url=}}</ref><ref name="pmid22915622">{{cite journal |vauthors=Poddubnyy D, Brandt H, Vahldiek J, Spiller I, Song IH, Rudwaleit M, Sieper J |title=The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic |journal=Ann. Rheum. Dis. |volume=71 |issue=12 |pages=1998–2001 |date=December 2012 |pmid=22915622 |doi=10.1136/annrheumdis-2012-201945 |url=}}</ref><ref name="pmid22859929">{{cite journal |vauthors=Ostergaard M, Lambert RG |title=Imaging in ankylosing spondylitis |journal=Ther Adv Musculoskelet Dis |volume=4 |issue=4 |pages=301–11 |date=August 2012 |pmid=22859929 |pmc=3403247 |doi=10.1177/1759720X11436240 |url=}}</ref>
* Joints widen before narrow
** [[Erosions]]
* Subchondral erosions, sclerosis, and proliferation on iliac side of SI joints
** [[Ankylosis]]  
* At endstage, sacroiliac joint may be a thin line or not visible
** Changes in [[joint]] width
* In the spine, early spondylitis is characterized by small erosions at the corners of vertebral bodies with reactive [[sclerosis]]
** [[Sclerosis]]
* Squaring of the vertebral body
* Fusion and large erosions more obvious as the disease becomes more advanced.
* [[Syndesmophyte]] formation, with bridging of the corners of one vertebra to another
* With the severity in [[x-ray]] [[Hip (anatomy)|hip]] involvement we can correlates the severity of the [[Spine|spinal]] disease.<ref name="pmid19755506">{{cite journal |vauthors=Baraliakos X, Braun J |title=Hip involvement in ankylosing spondylitis: what is the verdict? |journal=Rheumatology (Oxford) |volume=49 |issue=1 |pages=3–4 |date=January 2010 |pmid=19755506 |doi=10.1093/rheumatology/kep298 |url=}}</ref>
* [[Ossification]] of paravertebral connective tissue fibers, including posterior interspinous ligaments as well as linking of spinous processes leads to an appearance of a solid midline vertical dense line on AP projection
[[File:Ankylosing spondylitis Bamboo spine.jpg|center|thumb|Lateral Xray of neck showing complete fusion of anterior and posterior elements in ankylosing spondylitis, so called bamboo spine.
* May see associated [[pseudoarthroses]] (discovertebral destruction with adjacent sclerosis) and enthesopathic changes (ill-defined erosions with adjacent sclerosis at sites of ligamentous and tendenous attachments)
Source: Case courtesy of A.Prof Frank Gaillard, From the case <a href="https://radiopaedia.org/cases/2912">rID: 2912</a>
* Hip involvement is generally bilateral and symmetric, with uniform joint space narrowing, axial migration of the femoral head, and a collar of [[osteophyte]]s at the femoral head-neck junction
]]'''''Ankylosing spondylitis DAGGER SPINE'''''
* Knees demonstrate uniform joint space narrowing with bony proliferation
[[File:Ankylosing spondylitis DAGGER SPINE.jpg|center|thumb|X-ray Ap view of spine showing fusion of the spinous processes, so called dagger sign in AS
* Hands are generally involved asymmetrically, with smaller, shallower erosions and marginal [[periostitis]].
* Radiographs of the lungs may demonstrate progressive fibrosis and [[bullous]] changes at the apices. These lesions may resemble TB infection and bullae may become infected.
<gallery>
Image:Ankylosing-spondylitis-001.jpg|Bamboo Spine
</gallery>


A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced.
Case courtesy of A.Prof Frank Gaillard, From the case <a href="https://radiopaedia.org/cases/3382">rID: 3382</a>
]]


==References==
==References==

Latest revision as of 03:14, 30 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

An x-ray may be helpful in the diagnosis of ankylosing spondylitis (AS). Findings on an x-ray suggestive of ankylosing spondylitis (AS) include erosion and ankylosis of the sacroiliac joints.

X Ray

Lateral Xray of neck showing complete fusion of anterior and posterior elements in ankylosing spondylitis, so called bamboo spine. Source: Case courtesy of A.Prof Frank Gaillard, From the case <a href="https://radiopaedia.org/cases/2912">rID: 2912</a>

Ankylosing spondylitis DAGGER SPINE

X-ray Ap view of spine showing fusion of the spinous processes, so called dagger sign in AS Case courtesy of A.Prof Frank Gaillard, From the case <a href="https://radiopaedia.org/cases/3382">rID: 3382</a>

References

  1. Jang JH, Ward MM, Rucker AN, Reveille JD, Davis JC, Weisman MH, Learch TJ (January 2011). "Ankylosing spondylitis: patterns of radiographic involvement--a re-examination of accepted principles in a cohort of 769 patients". Radiology. 258 (1): 192–8. doi:10.1148/radiol.10100426. PMC 3009382. PMID 20971774.
  2. Poddubnyy D, Brandt H, Vahldiek J, Spiller I, Song IH, Rudwaleit M, Sieper J (December 2012). "The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic". Ann. Rheum. Dis. 71 (12): 1998–2001. doi:10.1136/annrheumdis-2012-201945. PMID 22915622.
  3. Ostergaard M, Lambert RG (August 2012). "Imaging in ankylosing spondylitis". Ther Adv Musculoskelet Dis. 4 (4): 301–11. doi:10.1177/1759720X11436240. PMC 3403247. PMID 22859929.
  4. Baraliakos X, Braun J (January 2010). "Hip involvement in ankylosing spondylitis: what is the verdict?". Rheumatology (Oxford). 49 (1): 3–4. doi:10.1093/rheumatology/kep298. PMID 19755506.

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