The symptoms of Ankylosing spondylitis is usally develop in adolescence or early adult life. The principal symptoms are low back pain and stiffness, and the presence of stiffness often helps to distinguish from other low back pain such vertebral collapse or nerve root inflammation.
The diagnose of Ankylosing spondylitis is likely to be present with stiffness and gets worse with inactivity and usually improve with exercise.
Charateristically, involvement of the sacroilliac joint is primarily respondsible for the symptoms and low back pain.
Systematic features such as pyrexia, fatique, weight loss or anaemia should increase the suspicion for diagnose.
Modified New York Criteria for diagnosis for ankyllosing spondyalitis (1984)
- LBP for least 3 months, improved by exercise, and not relieved by rest.
- Limitation of lumbarspine movement in sagital and frontal plane.
- Chest expansion decreased relative to normal values for age and sex
- Bilateral sacroilitis grade 2-4
- Unitaleral sacroilititis grade 2-4
Annueal assesment of spinal mobility, chest expansion, involvement of peripheral joints and entheses should be recorded. In addition, overall disability measure can also be used such as Bath AS Functional Index and the Health Assessment Questionnaire (HAQ).
Key point: If exercise are peceived to make a patient worse, particularly in the later stages, then investigations for a fracture or mobile segment should be undertaken and the segment programme alteration whilst this is done