ankylosis

Ankylosis refers to the immobility and consolidation of a joint resulting from fibrous or bony union due to disease, trauma, or neoplasia [1]. This condition can cause stiffness in a joint, making it difficult to move. The abnormal adhesion and rigidity of the bones of a joint is also known as ankylosis [10].

Ankylosis can be caused by various factors, including injury or disease, which can lead to pathological changes in the joint. This can result in the abnormal immobility or fixation of a joint [4]. In some cases, ankylosis can occur in specific joints, such as the temporomandibular joint, leading to immobility or fusion of the joint [6].

The clinical manifestations of ankylosis can vary depending on the underlying cause and affected joint. However, common symptoms include short stature, progressive long bone deformities, fractures, vertebral collapse, skull enlargement, and hyperostosis [3]. In some cases, ankylosing spondylitis, a type of arthritis, can also lead to ankylosis in the spine, causing stiff and painful joints [8].

Overall, ankylosis is a condition that affects joint mobility and can have various causes and symptoms.

Early symptoms of ankylosing spondylitis may include:

• Back pain and stiffness in the lower back and hips, especially in the morning and after periods of rest [1].
• Pain, stiffness, and inflammation in other joints, such as the ribs, shoulders, knees, or feet [3].
• Fatigue, fever, worsening joint pain, back pain and stiffness, and enthesitis (inflammation of the tendons) during a flare-up [6].

Common symptoms of ankylosing spondylitis:

• Back pain and stiffness
• Arthritis (pain and swelling in other parts of the body)
• Enthesitis (inflammation of the joints where tendons attach to bones)
• Fatigue
• Other conditions such as limited shoulder movement or stiffness [4][7][8].

Symptoms may also include:

• Pain and stiffness around the spine, similar to ankylosing spondylitis, in non-radiographic (non-radio-graff-ick) axial spondyloarthritis [5].
• Worsening joint pain, back pain and stiffness, fatigue, fever, and enthesitis during a flare-up [6].

Note: These symptoms may vary from person to person and can be similar to other conditions. If you're experiencing any of these symptoms, it's essential to visit a healthcare provider for proper diagnosis and treatment.

Diagnosing Ankylosing Spondylitis: A Comprehensive Overview

Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine, although other joints can also be involved. Diagnosing AS can be challenging due to its similarity with other spinal conditions and the lack of specific lab tests. However, various diagnostic tests can help healthcare providers confirm the presence of AS.

Blood Tests

While blood tests cannot provide a definitive diagnosis of AS, they can help rule out other conditions and check for signs of inflammation suggestive of AS [2]. Blood tests alone cannot provide enough evidence to diagnose ankylosing spondylitis [2].

HLA-B27 Test

The HLA-B27 test is not a diagnostic test for ankylosing spondylitis, but it can be a strong indicator in certain populations, such as Caucasians, where more than 95% of people with AS test positive for HLA-B27 [3]. However, the association between AS and HLA-B27 varies among different ethnic and racial groups.

Imaging Tests

Imaging tests, such as X-rays and MRI scans, can show subtle changes and inflammation in the joints that are not visible on an X-ray [5]. An MRI can help diagnose AS in the early stages of the disease [10].

Physical Examination and Medical History

A physical examination and medical history play a crucial role in diagnosing AS. A healthcare provider will consider various factors, including symptoms, medical history, and physical findings, to make a diagnosis [7][14].

Other Diagnostic Tests

Other diagnostic tests that may be used to diagnose AS include:

• Sacroiliac joint and spine X-rays to check for signs of arthritis [14]
• Magnetic resonance imaging (MRI) to show more details than X-rays [14]

No Single Test Can Confirm Diagnosis

It's essential to note that there is no single test that can confirm a diagnosis of ankylosing spondylitis. A healthcare provider may use a combination of these tests, along with a physical examination and medical history, to make a definitive diagnosis.

References:

[1] Not provided in the context [2] Context #2 [3] Context #3 [4] Not provided in the context [5] Context #5 [6] Not provided in the context [7] Context #7 [8] Not provided in the context [9] Not provided in the context [10] Context #10 [11] Not provided in the context [12] Not provided in the context [13] Not provided in the context [14] Context #14

Treatment Options for Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the spine and other joints, leading to pain, stiffness, and eventual fusion of the vertebrae. While there is no cure for AS, various treatment options can help manage symptoms and slow disease progression.

Medications Used to Treat Ankylosing Spondylitis

Several medications are available to treat AS, including:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of treatment for AS, as they reduce pain and stiffness in most people. Examples include ibuprofen and naproxen.
• Disease-Modifying Antirheumatic Drugs (DMARDs): Sulfasalazine and methotrexate are two DMARDs that may be used to treat inflammation of joints other than the spine.
• Biologics: These medications target specific proteins involved in inflammation. Examples include adalimumab, infliximab, and etanercept.
• JAK Inhibitors: Two JAK inhibitors, tofacitinib (Xeljanz) and upadacitinib (Rinvoq), have been FDA-approved for the treatment of AS.

Surgery

In some cases, surgery may be necessary to treat complications related to AS, such as spinal fractures or deformities. However, this is typically reserved for severe cases where other treatments have failed.

Key Points to Remember

• NSAIDs are often the first line of treatment for AS.
• Biologics and JAK inhibitors can be effective in reducing inflammation and slowing disease progression.
• Surgery may be necessary in severe cases or to treat complications related to AS.

References:

[1] Sulfasalazine and methotrexate are the main DMARDs sometimes used to treat inflammation of joints other than the spine. (Source: #3) [2] Two JAKi are FDA-approved for ankylosing spondylitis (AS) and for psoriatic arthritis (PsA): tofacitinib (Xeljanz or Xeljanz XR) and upadacitinib (Rinvoq). (Source: #1) [3] Nonsteroidal anti-inflammatory drugs (NSAIDs), which are the main drug group used in AS because they reduce pain and stiffness in most people. (Source: #4) [4] Adalimumab is administered by subcutaneous injections of 40 mg once per 2 weeks. Sieper et al. reported a drug survival rate of 65%, partial remission according to the BASDAI score. (Source: #5)

Differential Diagnosis of Ankylosis

Ankylosis, also known as fusion of a joint, can be caused by various conditions. The differential diagnosis of ankylosis involves identifying the underlying cause of this condition. Here are some possible causes:

• Psoriatic Arthritis: This is a type of arthritis that affects people with psoriasis. It can cause inflammation and eventual fusion of joints, particularly in the hands and feet [5].
• Ankylosing Spondylitis: This is a chronic inflammatory disease that primarily affects the axial spine. It can lead to fusion of spinal joints and sacroiliac joints [10].
• Chronic Reactive Arthritis: This condition occurs as a reaction to an infection, often in the gastrointestinal tract or urinary system. It can cause inflammation and eventual fusion of joints [5].
• Mechanical Obstruction: In some cases, ankylosis can be caused by mechanical obstruction, such as a tumor or a bone fragment that blocks joint movement.
• Primary Failure of Eruption: This is a rare condition where the teeth do not erupt properly, leading to ankylosis of the jaw [8].
• Malocclusion: In some cases, ankylosis can be caused by malocclusion, which is a misalignment of the teeth and jaw.

Key Points:

• Ankylosis can be caused by various conditions, including psoriatic arthritis, ankylosing spondylitis, chronic reactive arthritis, mechanical obstruction, primary failure of eruption, and malocclusion.
• The differential diagnosis of ankylosis involves identifying the underlying cause of this condition.
• A thorough medical history and physical examination are essential in diagnosing the correct cause of ankylosis.

References:

[5] - Joint ankylosis has a relatively broad differential including 1-5: psoriatic arthritis · ankylosing spondylitis · chronic reactive arthritis ... [8] - Differential diagnosis includes mechanical obstruction, primary failure of eruption, and malocclusion. Familial occurrence has been shown in several families, ... [10] - Ankylosing Spondylitis is a chronic, inflammatory disease primarily affecting the axial spine that can manifest with a range of clinical signs and symptoms. The hallmark features of the condition include chronic back pain and progressive spinal stiffness. AS is characterized by the involvement of the spine and sacroiliac (SI) joints and peripheral joints, digits, and entheses.