Ankylosing spondylitis

This usually presents with inflammatory back pain (sacroiliac joints and spine) and stiffness in young adults, and 20% present with peripheral joint involvement before the onset of back pain. It usually affects the girdle joints (hips and shoulders), knees or ankles. At some stage over 35% have joints other than the spine affected.

Key clinical features

• insidious onset of discomfort

• associated morning stiffness

• improvement with exercise or NSAIDs

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