At a Glance - Ankylosing spondylitis vs Pott disease

Contributed by Dr Jean Watkins, a retired GP in Hampshire

Pott disease commonly affects the thoracic and lumbosacral spine
Pott disease commonly affects the thoracic and lumbosacral spine

Ankylosing spondylitis
Aetiology

  • Uncertain cause but associated with the HLA-B27 gene.
  • More common in men. Usually presents in the 20-30 years age group.
  • Early diagnosis is important if irreversible spinal changes are to be avoided.

Presentation

  • Morning stiffness for more than 30 minutes.
  • Sleep disturbed by back pain. Pain improves with exercise.
  • Pain in the sacroiliac joints.
  • No associated sciatic pain and normal straight leg raising test.
  • Chest expansion reduced.
  • Thoracic kyphosis and loss of spinal flexion.

Management

  • Refer for X-ray of spine and sacroiliac joints.
  • ESR may be raised and may have normochromic anaemia.
  • Check for HLA-B27.
  • TNF blockers (etanercept and adalimumab) and NSAIDs.
  • Physiotherapy.

Pott disease (Tuberculous spondylitis)
Aetiology

  • Spinal TB usually involving one or more vertebrae.
  • Most commonly affects thoracic and lumbosacral spine.
  • Rare in the UK but common in developing countries and those with HIV.

Presentation

  • Back pain and radicular pain occur early.
  • Kyphosis.
  • Fever and weight loss.
  • Neurological damage presenting with paraplegia, nerve root pain, paraesthesia.
  • If cervical region involved may also suffer dysphagia, stridor and torticollis.
  • Complications are paraplegia and abscesses of paraspinal tissue and sinus tracts.

Management

  • CT scan and MRI to assess disc space infection and soft tissue.
  • Immobilise spine for two to three months.
  • Antituberculous therapy.
  • Isoniazid and rifampicin for nine to 12 months and two additional drugs for first two months: ethambutol or pyrazinamide.
  • Surgery to relieve compression and drain pus.

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