Ankylosing Spondylitis Remission
Squaring of the anterior border of the lower thoracic and lumbar vertebrae is one of the earliest radiographic features of ankylosing spondylitis, best demonstrated on the lateral radiograph of the spine (Fig. 4.28). As the condition progresses, delicate desmophytes are formed bridging the vertebral bodies, these have a vertical rather than horizontal orientation distinguishing them from osteophytes of degenerative disease. Paravertebral ossifications are also common. Apophyseal joint and vertebral body fusion usually later on in the course of the disease is a pathognomonic radiographic finding known as the 'bamboo spine' (Fig. 4.29). Sacro-iliac joint involvement is usually present with Complications of ankylosing spondylitis in the cervical spine include atlanto-axial subluxation (Fig. 4.31), which may become fixed with multilevel spinal fusion. Ankylosing spondylitis patients are more prone to fractures following relatively minor trauma. The fixed spinal segments can result in...
Most cases occur in the thoracic and lumbar spine (greater than 90 of cases), with the cervical spine involved in greater than 70 of cases (Fig. 4.32). The sacro-iliac joints are spared which can help to differentiate this condition from ankylosing spondylitis. This condition needs to be distinguished from the previously described 'bamboo spine' seen in ankylosing spondylitis. The sacro-iliac joints are usually spared in DISH, and usually no paravertebral ossification is seen (Fig. 4.34).
Gastrointestinal Haemorrhage, toxic megacolon, perforation, colonic carcinoma (in those with extensive disease for 10 years), gallstones and PSC. Extra-gastrointestinal manifestations (10-20 ) Uveitis, renal calculi, arthropathy, sacroiliitis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, osteoporosis (from steroid treatment), amyloidosis.
Lumbar spine 4 tumours, spondylitis, spondylodiscitis 4 scoliosis 4 spondylolisthesis lumbar spine 4 tumours, spondylitis, spondylodiscitis 4 scoliosis 4 spondylolisthesis lumbar spine and in the lumbosacral junction 4 tumours, spondylitis, spondylodiscitis 4 scoliosis 4 spondylolisthesis
The role of genetic factors in individual susceptibility may be seen in twins that are sometimes more liable to certain morbid conditions a comparison is made between monozygotic and dizygotic twins. In addition, immune deficiencies, whether cellular or humoral (e.g. agammaglobulinemia), are consequent on genetic factors, and such genetic failure may be responsible for altered patterns of disease, for example defective cellular immunity in lepro-matous leprosy. The clinical importance of the HLA genes in relation to transplantation and to possible abnormal immune response to some common chronic diseases has been recently emphasized, as has the remarkable association between HLS-B27 and ankylosing spondylitis and the possible association of Schistosoma mansoni hepatosplenomegaly and HLA-Aj and B5.