Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions), florid diskitis (Andersson lesions), early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures.
Early radiographic signs include squaring of the vertebral bodies caused by erosions of the superior and inferior margins of the vertebral bodies, resulting in loss of the normal concave contour of the anterior surface of the vertebral bodies (see the images below).
Early symptoms of ankylosing spondylitis might include back pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.
The hallmark feature of ankylosing spondylitis is the involvement of the sacroiliac (SI) joints during the progression of the disease. The SI joints are located at the base of the spine, where the spine joins the pelvis. More information on ankylosis and iritis can be found in the Complications section.
Hallmark radiographic features are bone erosions, new bone formation and ankylosis. Osteoporosis is also a prominent feature. Sacroiliac joints: The sacroiliac joint may be difficult to assess radiographically due to the obliquity of the joint and obscuration caused by overlying soft tissues.
There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but many different health problems can cause inflammation. Blood can be tested for the HLA-B27 gene.
A diagnosis of AS can usually be confirmed if an X-ray shows inflammation of the sacroiliac joints (sacroiliitis) and you have at least 1 of the following: at least 3 months of lower back pain that gets better with exercise and doesn't improve with rest. limited movement in your lower back (lumbar spine)
Evaluation of SIJ on pelvic X-rays according to the modified New York (mNY) criteria served for decades as the gold standard to ascertain a diagnosis of ankylosing spondylitis (AS) at a given time point.
Ankylosing spondylitis may affect more than the spine. The disease may inflame joints in the pelvis, shoulders, hips and knees, and between the spine and ribs.
Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions), florid diskitis (Andersson lesions), early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures.
Symptoms of ankylosing spondylitis vary from person to person. Some people have mild episodes of pain that come and go, while others will have chronic, severe pain. The symptoms of ankylosing spondylitis, whether mild or severe, may worsen in “flares” and improve during periods of remission.
If you have ankylosing spondylitis, you may have pain and stiffness at night, in the morning, or when you're not active. The pain may begin in the joints between your pelvis and spine and then move along your spine. Your pain may get better with movement or exercise.
People with Ankylosing Spondylitis often describe an ongoing, dull pain that feels like it's coming from deep within their lower back or buttocks, along with morning stiffness. It is not unusual for symptoms to worsen, get better or stop completely at regular intervals.
At this time, no single test diagnoses ankylosing spondylitis. Your doctor may order a blood test to check for the HLA-B27 gene, which is present in most people with the disease. You may have the HLA-B27 gene and never develop ankylosing spondylitis, but it can give doctors more information when making a diagnosis.
Over time this can damage the spine and lead to the growth of new bone. In some cases this can cause parts of the spine to join up (fuse) and lose flexibility (ankylosis). It's not known exactly what causes AS, but in many cases there seems to be a link with a particular gene variant known as HLA-B27.
Some foods can trigger ankylosing spondylitis, so it's important to avoid certain foods to prevent inflammation. These include foods that are high in fat, salt, and sugar; processed foods, dairy products, alcohol, caffeine, artificial sweeteners, and others.
In patients with advanced ankylosing spondylitis, multidetector CT (MDCT) scanning is the imaging modality of choice for the evaluation of fractures of the cervical spine. Magnetic resonance imaging (MRI) is useful in assessing early cartilage abnormalities and bone marrow edema.
Ankylosing spondylitis is a chronic inflammatory condition affecting the sacroiliac joints, the spine and sometimes the peripheral joints. It can be associated with enthesitis, iritis, dactylitis, psoriasis and inflammatory bowel disease.
Diagnosis of Ankylosing Spondylitis
Musculoskeletal imaging, specifically MRI, plays an important role in early diagnosis and monitoring of ankylosing spondylitis.
The Hallmark of Ankylosing Spondylitis
The hallmark of AS is involvement of the sacroiliac (SI) joints. Some physicians still rely on X-ray to show erosion typical of sacroiliitis, which is inflammation of the sacroiliac joints.
When it's time to see a specialist for ankylosing spondylitis (AS), you'll make an appointment with a rheumatologist. A rheumatologist is a doctor who focuses on diseases that affect your joints, muscles, and bones. They treat all types of arthritis, including AS.
Acute phase reactants such as erythrocyte sedimentation rate (ESR) and C-reactive protein are useful markers of inflammation but are elevated in only 50–70% of AS patients.