Typical Case of Ankylosing Spondylitis
Rohan is a 21-year-old student who has a two-year history of low back pain radiating down both buttocks and down the posterior aspect of his thighs. The pain and stiffness is eased with movement and exercise, but is much worse at night and with prolonged inactivity. The patient has significant night pain, which prevents him from sleeping properly. The patient also has profound fatigue and difficulty continuing studying in library. Examination revealed a reduced forward flexion of the spine. The patient also had reduced chest expansion of 2cm across the fourth rib space.
The routine bloods (FBC and biochemistry) were normal but the inflammatory markers were elevated ESR = 41, CRP = 21. X-rays of the lumbar sacral spine revealed early symdesmophyte formation. X-rays of the sacroiliac joints showed sclerosis of the lower one-third of the sacroiliac joint, indicating sacroiliitis. Andrew was referred to a rheumatologist and was diagnosed with ankylosing spondylitis.