Chronic inflammatory arthritis of the sacroiliac joints and spine, strongly HLA-B27 associated.
Clinical features
- • Inflammatory back pain <45 y, >3 months
- • Morning stiffness >30 min improving with exercise
- • Alternating buttock pain
- • Enthesitis, dactylitis, anterior uveitis
Investigations
- • MRI sacroiliac joints (bone marrow oedema) — earliest change
- • X-ray: sacroiliitis, syndesmophytes, bamboo spine
- • HLA-B27, CRP
- • Schober's test
Management
- • Daily physiotherapy and spinal extension exercises
- • NSAIDs at maximum tolerated dose
- • Anti-TNF or IL-17 inhibitor if BASDAI ≥4 after 2 NSAIDs
- • Smoking cessation
Complications
- • Spinal fusion and fracture risk
- • Anterior uveitis
- • Aortic regurgitation
- • Apical lung fibrosis
Clinical pearls
- • Rigid spine fractures with minimal trauma — image the whole spine after any fall
Educational — verify locally.
