Скачать или смотреть Case Study 189: Ankylosing Spondylitis (AS) | Dr. Betsy Grunch explains

🦴 Case Study 189: Ankylosing Spondylitis (AS)
Chronic back pain in a 24-year-old female, worse in the morning, improving with activity.
After years of misdiagnoses and dismissals, the answer finally came: Ankylosing Spondylitis.

📊 Key Facts:
• 🕒 Avg delay to diagnosis: 6–8 years, especially in women
• 🔍 HLA-B27: Positive in ~90% of White patients with AS, but less common in Black and Asian patients
• 📈 Prevalence: ~0.1–1.4% globally
• 🧠 Often missed due to gradual onset, subtle early signs, and overlap with mechanical back pain

🧬 Pathophysiology:
Autoimmune inflammation begins at the entheses (where ligaments insert on bone), progressing to spinal fusion via syndesmophytes. It’s not just a “spine disease” - it’s systemic.

🫀 Extra-spinal features:
• Uveitis (25–30%)
• IBD (~7%)
• Psoriasis (~10%)
• Cardiovascular and pulmonary complications in advanced stages

💡 Remember: Chronic low back pain that improves with exercise and not rest? Think inflammatory. Early MRI can reveal sacroiliitis before X-rays do.

🧘‍♀️ Treatment
• NSAIDs = first-line
• TNF or IL-17 inhibitors for moderate/severe disease
• Physical therapy is essential
• Avoid spinal fusion with early recognition and action

📚 Takeaway: If your patient is young, stiff in the morning, and dismissed for years - look again. AS hides in plain sight.

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