Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • HLA-B27 positive
  • positive FHx AS
  • inflammatory back pain
  • iritis
  • enthesitis
  • presentation in late teens and early 20s
  • male gender

Other diagnostic factors

  • fatigue
  • sleep disturbance
  • tenderness at sacroiliac joint
  • dyspnea
  • loss of lumbar lordosis
  • peripheral joint involvement
  • kyphosis
  • psoriasis
  • symptoms of inflammatory bowel disease

Risk factors

  • HLA-B27
  • endoplasmic reticulum aminopeptidase 1 (ERAP1) and interleukin 23 receptor (IL23R) genes
  • positive FHx AS
  • Klebsiella pneumoniae

Diagnostic investigations

Investigations to consider

  • HLA-B27
  • MRI
  • cervical spine x-ray (lateral)
  • lumbar spine x-ray (lateral)
  • thoracic spine x-ray (lateral)
  • ultrasound
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant

Rheumatology Department

Royal Berkshire NHS Foundation Trust

Reading

UK

Disclosures

AC has served on the advisory boards for MSD and Sanofi; contributed to educational events for Janssen, MSD, Novartis, and Celgene; been on the speaker bureau for Janssen, Pfizer, and Novartis; and received travel grants from Abbvie, UCB, and Pfizer to attend educational conferences.

Specialist Registrar in Rheumatology

Royal Berkshire NHS Foundation Trust

Reading

UK

Disclosures

JG declares that she has no competing interests.

Dr Antoni Chan and Dr Jessica Gunn would like to gratefully acknowledge Dr Sarah Keidel, Dr Millicent Stone, Dr Raj Sengupta, Dr Athimalaipet V. Ramanan, and Dr Emma Pomeroy, the previous contributors to this monograph. SK declares that she has no competing interests. MS is an author of several references cited in this monograph. RS declares that he has no competing interests. AR declares that he has no competing interests. EP is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

Professor of Rheumatology

Centre for Rheumatic Diseases

University Department of Medicine

Glasgow Royal Infirmary University Trust

Glasgow

UK

Disclosures

RS is an author of a reference cited in this monograph.

Consultant Physician and Rheumatologist

Northwick Park Hospital

Harrow

UK

Disclosures

AK declares that he has no competing interests.

Consultant

Norfolk and Norwich University Hospital

Norwich and the Cromer & District Hospital

Cromer

UK

Disclosures

KG is an author of a reference cited in this monograph.

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic

Burlington

MA

Disclosures

AGC declares that he has no competing interests.

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