This is a chronic inflammatory arthritis especially affecting sacroiliac joints and spine and characterized by progressive stiffening and fusion of the axial skeleton.
• Age: 20-30 years.
• Sex: Male & female ratio 4: 1
• More than 90% of affected persons carry the histocompatibility antigen HLA-B-27.
• Onset: Insidious, occasionally acute resembling lumbar disc protrusion.
• Back pain: Recurring episodes of low back pain and stiffness sometimes radiating to the buttocks or thighs. Pan is worse in the early morning and after inactivity.
• Chest Pain: Chest pain aggravated by breathing results from the involvement of the costovertebral joints.
• Heel Pain: due to plantar fasciitis.
• Failure to obliterate the lumbar lordosis on forward flexion.
• Pain on sacroiliac compression
• Tenderness over a bony prominence such as iliac crest, ischial tuberosity and greater trochanter.
• Restriction of movements of lumbar spines in all directions.
• As the disease progresses, stiffness increases throughout the spine.
• Iritis occurs in 25% of patients.
• Aortic regurgitation
• ESR – often raised
• RA factor absent.
• HLA B-27 in 90% cases, (present in 8% of normal population).
X-ray lumbar sine
• The sacroiliac joints are eroded with irregular margins and sclerosis of adjacent bone. As the disease advances, the sacroiliac joints may fuse.
• Syndesmophyte: It is a characteristic
abnormality in the spinal column, characterized by calcification and ossification of the interspinous ligaments, appearing as continuous lines. Therefore called “ tramline appearance”.
• Vertebrae appear square as a result of erosion of their comers.
MRI Lumbosacral spine
Non-steroidal anti-inflammatory drugs NSAIDs.
These drugs are very effective in relieving night pain and morning stiffness.
Regular exercise to prevent deformities.
• Sulhasalazine for long-term suppression in the involvement of peripheral arthritis
• Steroids: local steroid injection can be helpful for plantar fasciitis.
Refer to rheumatologist