Ankylosing spondylitis: Which description best fits the diagnosis?

Ankylosing spondylitis: Which description best fits the diagnosis?

• A. Older female with hand joint swelling and morning stiffness
• B. Young male with positive HLA-B27; back pain and stiffness that improves with exercise, morning stiffness, and sacroiliac joint changes
• C. Child with ankle sprain
• D. Elderly man with osteoporosis

Answer: (B)

An inflammatory back pain pattern in a young man, especially with HLA-B27 positivity and sacroiliac joint involvement, is classic for ankylosing spondylitis. Inflammatory back pain tends to start in late adolescence or early adulthood, is worse with rest and improves with exercise, and is accompanied by morning stiffness that lasts 30 minutes or more. The sacroiliac joints are a common early site of disease, and the association with HLA-B27 is a notable association. This combination—young male with back pain and stiffness that gets better with activity, morning stiffness, and sacroiliac joint changes with a positive HLA-B27—fits ankylosing spondylitis best. The other descriptions don’t fit this pattern: an older female with hand joint swelling suggests a seropositive inflammatory arthritis like rheumatoid arthritis; a child with an ankle sprain describes an acute, traumatic injury; an elderly man with osteoporosis points to a degenerative or metabolic bone issue rather than inflammatory back pain with sacroiliitis.

An inflammatory back pain pattern in a young man, especially with HLA-B27 positivity and sacroiliac joint involvement, is classic for ankylosing spondylitis. Inflammatory back pain tends to start in late adolescence or early adulthood, is worse with rest and improves with exercise, and is accompanied by morning stiffness that lasts 30 minutes or more. The sacroiliac joints are a common early site of disease, and the association with HLA-B27 is a notable association. This combination—young male with back pain and stiffness that gets better with activity, morning stiffness, and sacroiliac joint changes with a positive HLA-B27—fits ankylosing spondylitis best.

The other descriptions don’t fit this pattern: an older female with hand joint swelling suggests a seropositive inflammatory arthritis like rheumatoid arthritis; a child with an ankle sprain describes an acute, traumatic injury; an elderly man with osteoporosis points to a degenerative or metabolic bone issue rather than inflammatory back pain with sacroiliitis.