Unknown #132

A 32 year old man is evaluated for low

back pain. He states he is an avid
basketball player, and began to notice
back pain three months ago, most
mornings after participating in long
basketball games. The pain is not
noticeable while he is playing basketball.
For the past three weeks, he has had
worsening back pain in the morning which
lasts approximately 60 minutes. He has
tried occasional ibuprofen with some relief.
He is otherwise in good health, and takes
no other medications. Review of systems
is positive for fatigue and mild generalized
“joint aches.”
On physical exam, he appears well. Vital
signs are normal. Conjunctiva are slightly
red bilaterally. Cardiac, pulmonary and
abdominal exams are normal. There is no
small joins synovitis. You ask him to flex
his spine (touch his toes) and note that he
has 4 cm of expansion in the lumbar spine
when going from an erect posture to
flexed.
Which of the following is most likely to
confirm your suspected diagnosis?

A) Blood cultures for neisseria gonorrhea

B) Serum rheumatoid factor levels
C) HLA-B27 gene testing
D) X-rays of the spine
E) Anti nuclear antigen testing
Which of the following is most likely to
confirm your suspected diagnosis?

A) Blood cultures for neisseria gonorrhea

B) Serum rheumatoid factor levels
C) HLA-B27 gene testing
D) X-rays of the spine
E) Anti nuclear antigen testing
 Ankylosing spondylitis
Seronegative spondyloarthropathy
Young men
Inflammatory symptoms (morning stiffness),
peripheral arthropathy and enthesithis
Also associated with systemic symptoms
– Fatigue
– Fever
– Weight loss
– Anorexia
Associated with uveitis, cardiac involvement, and
some other extraarticular involvement
 Ankylosing spondylitis
HLA-B27 associated
– But not diagnostic, since B27 positivity is
common
Appropriate history plus radiographic
findings (sacroiliitis) confirm diagnosis
Schöber test may be positive (mark at L5
and 10 cm above, ask patient to flex
spine, normal expansion is >5 cm)

OBJECTIVE: Confirm a suspected diagnosis of chronic ankylosing

spondylitis.