U.C.L.A. Rheumatology Pathophysiology of Disease Course Lecture,
Second Year Medical School 1997

  
 
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Ankylosing Spondylitis     Page 20
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       eventually bridges the capsules and discs between the vertebral bodies (figure 2-3) . The entire axial skeleton may be transformed into a solid column of bone resulting in almost complete loss of forward and lateral flexion as well as rotation of the neck and back.
       Early in AS chest expansion is reduced since the ligaments attaching the ribs to both the vertebrae and the sternum become inflamed. The muscles around the shoulder and hip girdles become very tight. Sometimes the shoulder and hip capsules become inflamed. This causes pain and restricted motion. The synovium may become inflamed but it is not a primary target as in RA. Heel pain may be a prominent feature; this is caused by an enthesopathy (inflammation of the enthesis) because the site of inflammation is where the Achilles tendon and the plantar fascia attach to the calcaneus (figure 4). 
      AS tends to affect principally the axial skeleton, with stiffness and restricted motion in the spine. Peripheral joints are only affected in 25% of patients. The eye may become inflamed acutely because of an iritis. Long-standing AS is associated with dilatation of the aortic root and scarring of the aortic valve cusps, resulting in aortic insufficiency. An unusual scarring of the apex of the lungs 		   
Figure 2. This xray of the thoracic spine in a patient with AS demonstrates a lateral syndesmophyte (bony overgrowth, white heavy headed arrow ) The red arrow shows a space where there are only degenerative changes. Click thumbnail figure to view full graphic. jpeg 219 x 164 pixels 12kbs freehand 3dstudio max
Click Picture or here for larger slide and further discussion (640 x 480) 60kb
   
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