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Ankylosing Spondylitis, Emergency Medicine

Daniel R. Lasoff and Brian K. Snyder Reviewed 06/2017
 


Basics

Description

  • Chronic inflammatory disease, primarily affects the axial skeleton with predilection toward the spine and sacroiliac (SI) joints:

    • SI joints 100%

    • Cervical spine 75%

    • Thoracic spine 70%

    • LS ...

Diagnosis

Signs and Symptoms

  • Spinal: Low back pain with sacroiliitis is the most common presentation:

    • Inflammatory back pain, improving with movement and exercise.

    • Higher risk for serious injury from mil...

Treatment

Pre-Hospital

  • High risk of spinal injury from minor trauma.

  • Spinal immobilization must avoid creating further injury:

    • Cushion stabilization and scoop board in position of comfort may be a better...

Follow-Up

Disposition

Admission Criteria

  • Acute neurologic impairment

  • Intractable pain

  • Sepsis or septic joint cannot be excluded.

Discharge Criteria

  • No serious injuries or neurologic deficit

  • Pain is manageabl...

Pearls and Pitfalls

  • Intubation is likely to be difficult and should avoid neck repositioning due to risk of C1 subluxation.

    • Consider airway adjuncts (such as LMA) until a definitive airway (usually fib...

Additional Reading

  • Baraliakos  X, van den Berg  R, Braun  J, et al. Update of the literature review on treatment with biologics as a basis for the first update of the ASAS/EULAR management recommendat...

Codes

ICD9

720.0 Ankylosing spondylitis 

ICD10

  • M45.2 Ankylosing spondylitis of cervical region

  • M45.8 Ankylosing spondylitis sacral and sacrococcygeal region

  • M45.9 Ankylosing spondylitis of unspecified site...

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