Ankylosing Spondylitis




Risk




  • •

    1:2000 incidence in Caucasians; rare in non-Caucasians


  • •

    M:F 10:1; more severe in males


  • •

    18-50% incidence in Native Americans





Perioperative Risks




  • •

    Difficult airway and atlantoaxial instability


  • •

    “Bamboo spine” with potential for fracture during airway manipulation


  • •

    Rigid chest with difficult ventilation


  • •

    Myocarditis and myocardial conduction defects


  • •

    Increased blood loss due to abnormal chest structure or mechanics





Perioperative Risks




  • •

    Difficult airway and atlantoaxial instability


  • •

    “Bamboo spine” with potential for fracture during airway manipulation


  • •

    Rigid chest with difficult ventilation


  • •

    Myocarditis and myocardial conduction defects


  • •

    Increased blood loss due to abnormal chest structure or mechanics





Worry About




  • •

    Inability to intubate, spine fracture, arrhythmia, inability to ventilate, and massive blood loss


  • •

    Airway edema after extubation





Overview




  • •

    An arthritic process, seronegative for rheumatoid factor, which attacks ligamentous attachments of the spinal column


  • •

    Characterized by low-back pain, sacroiliitis, multiplane rigidity of the spine, chest stiffness, uveitis, and insidious onset at <40 y of age


  • •

    Autosomal dominant and strongly prevalent among first-degree relatives





Etiology




  • •

    Etiology unknown


  • •

    Genetic transmission led to discovery of a genetic marker, HLA-B27. Also involved are the major histocompatibility complex, numerous HLA-B27 subtypes, IL23R (also associated with ulcerative colitis), and ERAP-1.


  • •

    Infectious origin speculated; one species of klebsiella is reported to be associated with some cases.





Usual Treatment




  • •

    Symptomatic, with exercise and NSAIDs; Immunosuppression can be tried in severe cases.


  • •

    Wedge osteotomy is a drastic surgical intervention.


  • •

    Infliximab: monoclonal antibody specific for TNF.


  • •

    Etanercept: Anti-TNF protein.


  • •

    Adalimumab: Monoclonal antibody specific for TNF.


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Sep 1, 2018 | Posted by in ANESTHESIA | Comments Off on Ankylosing Spondylitis

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