Presented by MD.Monsur Rahman MPT (Musculoskeletal Disorders) MM INSTITUTE OF PHYSIOTHERAPY & REHABILITATION MM UNIVERSITY, MULLANA, AMBALA

1. Presented
By
MD. MONSUR RAHMAN
MM INSTITUTE OF PHYSIOTHERAPY & REHABILITATION
MULLANA, AMBALA
MPT (Musculoskeletal Disorders)

2. Ankylosing Spondylitis
Ankylosing spondylitis is a
form of arthritis that mainly
affects the spine and sacroiliac
joints, or the lower back
Ankylosing spondylitis can
be difficult to diagnose but has
a particular pattern of pain
symptoms, and changes can be
seen on X-ray and MRI

3.  Pain In The Lower Back, Hips, And Buttocks
 Stiffness In The Lower Back, Hips, And Buttocks
 Neck Pain
 Ligament And Tendon Pain
 Tiredness
 Night Sweats
 Mild Fever
 Appetite Loss
 General Discomfort

4.  At this stage, signs and symptoms include pain,
stiffness, and tenderness on both sides of the body
 These symptoms often spread to other body parts.
 AS can eventually lead to changes in posture
 Tiredness, caused by the body's reaction
to inflammation, is another common long-term
symptom.

5.  The Spine
 Neck
 Ribs
 Shoulder Joints
 Hips
 Thighs
 Joints Of The Hands
 Joints Of The Feet

6.  Causes
 The cause of AS is unknown.
 People with the HLA-B27 gene are at greater
risk of developing the condition
 Risk factors :
 Age ( 15 to 40)
 Sex(Approximately Three Times More men
than women)
 Genetics And Family History

7. Physical examination
Diagnostic criteria include:
 Inflammatory back pain:Chronic, inflammatory back pain
is defined when at least four out of five of the following
parameters are present: (1) Age of onset below 40 years
old, (2) insidious onset, (3) improvement with exercise,
(4) no improvement with rest, and (5) pain at night (with
improvement upon getting up)
 Past history of inflammation in the joints, heels, or
tendon-bone attachments
 Family history for axial spondyloarthritis

8.  Positive for the biomarker HLA-B27
 Good response to treatment with nonsteroidal anti-
inflammatory drugs (NSAIDs)
 Signs of elevated inflammation (C-reactive
protein and erythrocyte sedimentation rate)
 Manifestation of psoriasis, inflammatory bowel
disease, or inflammation of the eye (uveitis)
 If these criteria still do not give a compelling
diagnosis magnetic resonance imaging (MRI) may be
useful

9.  Blood tests
 Doctors may also request blood tests to detect the
presence of the HLA-B27 gene.
 This gene is present in up to 95% of white people in
central Europe and North America who have AS.
 However, not everyone with the gene goes on to
develop AS.
 Only 1 to 2 percent of people with the HLA-B27 gene
are affected by the condition.

10. Imaging Tests
 X-rays may be performed on the spine to see if the joints
are damaged or fused
 May order a MRI scan if nothing shows up on the X-ray.
MRI scan detect inflammation without joint damage.

11.  Physical Therapies And Exercises
 Advice
 Drugs
 Surgery, In Rare Cases

12.  Early intervention with physical and occupational
therapy is important to maintain function and
minimize deformity.
Exercise programme.
 A program of daily exercise helps reduce stiffness,
strengthen the muscles around the joints and prevent
or minimize the risk of disability.
 Deep breathing exercises may help keep the chest
cage flexible.
 Swimming is an excellent form of exercise for people
with ankylosing spondylitis.

13.  Moderate-to-high impact exercises like jogging are
generally not recommended or recommended with
restrictions due to the jarring of affected vertebrae
that can worsen pain and stiffness in some with AS
 Exercise programs, either at home or supervised
 Group exercises
 Proprioceptive neuromuscular facilitation (PNF)
Electro therapy:
 Transcutaneous electrical nerve stimulation(TENS)
 Hot Compression

14.  The main drugs used to ease the pain and
inflammation of AS are nonsteroidal anti-
inflammatory drugs (NSAIDs).
 Examples include ibuprofen, naproxen, and
diclofenac. Acetaminophen and codeine are also
options if NSAIDs are unsuitable or insufficient.

15.  Locally injected corticosteroids
 Disease-modifying anti-rheumatic drugs (dmards),
such as sulfasalazine (brand names: azulfidine or
sulfazine) and methotrexate (otrexup, rheumatrex, or
trexall)
 Tumor necrosis factor (TNF) antagonists, such
as adalimumab (humira), certolizumab
(cimzia), etanercept (enbrel), golimumab (simponi),
or infliximab (remicade)
 Other biologic treatments, such as secukinumab
(cosentyx)

16.  Artificial joint replacement surgery may be a
treatment option for some people with advanced joint
disease affecting the hips or knees.

17. Thank You