Rapid Review: Ankylosing Spondylitis

July 10, 2017

Reviewed January 2024

Ankylosing Spondylitis (Radiographic Axial Spondyloarthritis)

  • Risk factors: male sex, age < 40
  • Sx: low back pain that’s most severe at night and morning stiffness that improves with exercise
  • PE: limited spinal mobility, decreased lumbar lordosis
  • X-ray: squared vertebral bodies, multiple vertebral fusions (bamboo spine)
  • Labs: increased ESR, positive HLA-B27
  • Treatment options include NSAIDs, physical therapy, TNF-alpha blockers
  • Associated with: uveitis, aortitis, IBD, psoriasis, apical pulmonary fibrosis
  • Diseases associated with HLA-B27: PAIR
    • Psoriatic arthritis
    • Ankylosing spondylitis
    • Inflammatory bowel disease
    • Reactive arthritis

Sample question: A 51-year-old man presents with low back pain that has been worsening over the past several years. Radiographs of the spine demonstrate fusion of the sacroiliac joints and a bamboo spine.” Blood tests reveal that he is human leukocyte antigen B27 positive. Which of the following findings on physical exam would be most consistent with the suspected diagnosis?

By Yehuda Wolf, MPA, PA-C

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