A 25 year old man presents to your clinic with low back pain that improves with exercise but not rest. It had an insidious onset and occurs at night. He also has buttock, hip, shoulder, TMJ, and posterior thigh pain. He had an episode of anterior uveitis a month ago. Review of systems is notable for fatigue.Physical exam is remarkable in that the patient is stooped; you note loss of normal lumbar lordosis, increased flexion of the neck, and increased thoracic kyphosis.
Challenge: What's your diagnosis?
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Ankylosing spondylitis
ankylosing spondylitis!
one of the seronegative spondylopathies
must have been too easy ;)
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Dinosaur
The picture is of an ankylosaurus; this is ankylosing spondylitis (ankylos means bent or crooked in Greek). Ankylosing spondylitis is a chronic inflammatory disease of the axial skeleton and the enthesis (ligament insertion into bone). It is associated with HLA-B27.
Sources: UpToDate; Wikipedia.
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