Last reviewed: 28 Dec 2020
Last updated: 13 Jan 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • peripheral arthritis
  • axial arthritis

Other diagnostic factors

  • constitutional symptoms
  • enthesitis
  • mucous membrane involvement
  • skin rash
  • circinate balanitis
  • ocular manifestations
  • cardiac manifestations

Risk factors

  • male sex
  • HLA-B27 genotype
  • preceding chlamydial or gastrointestinal infection
  • BCG immunotherapy

Diagnostic investigations

1st investigations to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • antinuclear antibody (ANA)
  • rheumatoid factor
  • urogenital and stool cultures
  • plain x-rays
  • arthrocentesis with synovial fluid analysis
More 1st investigations to order

Investigations to consider

  • HLA-B27
  • nucleic acid amplification tests
  • MRI
  • ultrasound
More investigations to consider

Treatment algorithm


Professor of Medicine

Division of Rheumatology


University of South Florida College of Medicine




JDC is on the speakers bureau for Abbvie and Amgen. JDC is a co-author of several references cited in this topic.

Dr John D. Carter would like to gratefully acknowledge Dr Jason P. Guthrie, a previous contributor to this topic. JPG declares that he has no competing interests.

Peer reviewersVIEW ALL

Professor of Rheumatology

University of Cambridge




JSHG declares that he has no competing interests.

Professor and Chief

Section of Rheumatology

Department of Internal Medicine

LSU Health Sciences Center

New Orleans



LRE is a co-author of several references cited in this topic. Unfortunately, we have since been made aware that Dr Luis R. Espinoza is deceased.

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