Ankylosing Spondylitis (cont.)
How is ankylosing spondylitis diagnosed?
The diagnosis of ankylosing spondylitis is based
on evaluating the patient's symptoms, a physical examination,
X-ray findings, and blood tests. Stiffness, pain, and decreased range of motion of the spine are characteristic of the inflammatory back pain of ankylosing spondylitis. Symptoms include pain and morning
stiffness of the spine and sacral areas with or without accompanying
inflammation in other joints, tendons, and organs. Early symptoms
of ankylosing spondylitis can be very deceptive, as stiffness
and pain in the low back can be seen in many other conditions. It can
be particularly subtle in women, who tend to (though not always) have
more mild spine involvement.
Years can pass before the diagnosis of ankylosing spondylitis
is even considered.
The examination can demonstrate signs of inflammation and
decreased range of motion of joints. This can be particularly
apparent in the spine. Flexibility of the low back and/or neck can be
decreased. There may be tenderness of the sacroiliac joints of the
upper buttocks. The expansion of the chest with full breathing can be
limited because of rigidity of the chest wall. Severely affected
people can have a stooped posture. Inflammation of the eyes can be
evaluated by the doctor with an ophthalmoscope.
Further clues to the diagnosis are suggested by X-ray abnormalities of the
spine and the presence of the genetic marker HLA-B27 identified by
a blood test. Other blood tests may provide
evidence of inflammation in the body. For example, a blood test
called the sedimentation rate is a nonspecific marker for inflammation
throughout the body and is often elevated in inflammatory conditions such
as ankylosing spondylitis. Urinalysis is often done to look for
accompanying abnormalities of the kidney as well as to exclude
kidney conditions that may produce back pain that mimics ankylosing
spondylitis. Patients are also simultaneously evaluated for symptoms and signs
of other related spondyloarthropathies, such as psoriasis,
venereal disease, dysentery (reactive arthritis or Reiter's disease), and inflammatory
bowel disease (ulcerative colitis or Crohn's disease).
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