Typical profile of ankylosing spondylitis

Age and sex:

• Young men 15-30 (rare onset after 40) History of injury:

• None, unless coincidental

• Has a slow insidious onset

Site and radiation:

• Low back, may radiate to both buttocks or posterior thigh (rare below knees)

• Can alternate sides

Type of pain:

• Aching, throbbing pain of inflammation

• Commonly episodic Aggravation:

• Often worse at night (can wake patient), turning over in bed and rising in the morning Relief:

• Activity including exercise

• Patient may walk around during night for relief

Associations:

• Back stiffness, especially in morning

• Pain and stiffness in thoracic or cervical spine

• Pain and stiffness in thoracic cage

Physical examination (significant):

• Absent lumbar lordosis

• Lateral flexion limited first, then flexion and extension

• Positive sacroiliac joint stress tests

• Positive Schober's test

Diagnosis confirmation:

• X-ray of pelvis (sacroiliitis)

• Bone scans and CT scans

• ESR usually elevated

• HLA-B27 antigen positive in over 90% of cases (10% of population are positive)

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