Ankylosing%20spondylitis Signs and Symptoms

• Axial spondyloarthritis (SpA) refers to a group of chronic inflammatory rheumatic diseases characterized by spinal and joint oligoarthritis, enthesitis, and sometimes, mucocutaneous, ocular, and/or cardiac manifestations 
  • SpA is characterized by articular inflammation, erosion and new bone formation at peripheral and axial sites
    • Strong tendency to affect the spine, especially the sacroiliac joints
• Divided into two subgroups, depending on the presence of sacroiliitis on plain radiography:
  • Ankylosing spondylitis (AS) or radiographic axial SpA - features sacroiliitis
  • Non-radiographic axial SpA - absence of sacroiliitis

• AS is a prototype of SpA, particularly of the axial form of SpA
• Most common inflammatory disorder involving the axial skeleton
• Predominantly seen in male individuals

Main Clinical Manifestations of Axial Spondyloarthritis

• Inflammatory chronic back pain persisting for >3 months with four of the following characteristics:
  • Onset before 40 years of age
  • Insidious onset
  • Improves with exercise
  • Nocturnal pain with improvement upon getting up
  • Associated with morning stiffness not improved by rest
• Synovitis
• Peripheral arthritis
• Ankylosis
• Dactylitis (finger or toe inflammation resulting in a sausage appearance)
• Inflammation of the attachments of ligaments and tendons to bones (enthesitis)
• Extra-articular manifestations such as anterior uveitis, psoriasis, inflammatory bowel disease (IBD)

Clinical Manifestations of Ankylosing Spondylitis

• Inflammatory chronic back pain and stiffness
• Chest pain/costochondritis
• Alternate buttock pain
• Acute anterior uveitis
• Asymmetric oligoarthritis predominantly of lower limbs
• Enthesitis (eg heel, plantar)
• Radiographic sacroiliitis
• Positive family history of AS, chronic IBD or psoriasis
  

Clinical Manifestations of Non-Radiographic Axial Spondyloarthritis

• Vertebrae structural abnormalities are less severe in non-radiographic axial SpA than advanced AS
• There is a higher prevalence of occurrence of enthesitis in non-radiographic axial SpA than AS
• Dactylitis 
• Asymptomatic ileac and colonic mucosal ulcerations (occur in 50% of patients)
• Psoriasis (occurs in 10% of patients)