QJM: An International Journal of Medicine, 2018, 913–914
doi: 10.1093/qjmed/hcy158
CLINICAL PICTURE
Ankylosing spondylitis and bamboo spine
Ankylosing spondylitis and bamboo spine
A 38-year-old gentleman presented with a history of a low back-
ache for 10 years. The pain was mild to moderate in intensity,
increasing with rest and during the second half of the night and
relieved by stretching or with routine activity. On examination,
he had positive Schober’s test and restricted chest expansion.
Investigation showed, CRP 10 mg/dl and ESR of 44 mm/h. He
was tested negative for rheumatoid factor and anti-nuclear
antibody. The patient underwent X-ray dorsolumbar spine and
bilateral sacroiliac joint, which showed bamboo stick appear-
ance of the lumbar spine (Figure 1A) and sacroiliitis (Figure 1B).
His MRI lumbosacral spine images showed evidence of sacroilii-
tis. He was positive for the HLA-B27 allele, confirming the diag-
nosis of ankylosing spondylitis (AS). The patient was managed
with physiotherapy and etoricoxib, an NSAID (non-steroidal
anti-inflammatory drug). Three months, later on, follow up,
though continuing the therapy he was asymptomatic.
Inflammatory back pain is characterized by young age at
onset (<45 years), early morning stiffness and pain, which
improves with activity or stretching and again worsens by rest.1
In population-based studies, the incidence of Inflammatory back
Figure 1. (A) Plain X-ray of the thoraco-lumber spine showing fusion (ankylosis) of vertebral bodies (Bamboo spine) due to syndesmophytes (black arrows). (B) Plain
X-ray of the hip bone showing fusion of sacroiliac joint (arrow head) and thickening of hip joint (arrow).
C The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Clinical picture
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pain has been estimated at 0.8–1.4%.2,3 The common causes in-
clude AS, inflammatory bowel disease, psoriasis, reactive arth-
ritis and undifferentiated spondyloarthropathy.1AS is diagnosed
based on clinical (Inflammatory spondyloarthropathy) and radio-
logical features (X-ray or MRI of sacroiliac joint). Presence of HLA-
B27 allele is associated with increased risk of AS (odds
ratio > 50).4 The bamboo spine appearance on X-ray is due to the
development of marginal syndesmophytes leading to fusion of
vertebral bodies.5 The first line treatment is with NSAIDs, and in
poor responders, tumor necrosis factor inhibitors are recommen-
ded.4 Care full history, examination and radiographic picture are
essential for diagnosis and with start of early treatment, one can
avoid permanent disability from the disease.
Photographs and text from: R. Sandal, K. Mishra, A. Jandial,
A. Khadwal and P. Malhotra, Department of Internal Medicine,
Post-Graduate Institute of Medical Education and Research,
Chandigarh 160012, India. email: mishrak20@gmail.com
Conflict of interest: None declared.
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axial spondyloarthritis. N Engl J Med 2016; 374:2563–74.
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