Clinical Manifestation and Diagnosis of Ankylosing Spondylitis / 대한내과학회지

ABSTRACT

Ankylosing spondylitis (AS) is the main disease entity within spondyloarthritides. AS patients can present with both articular and extra-articular manifestations. Especially, inflammatory back pain has been recognized as the main symptom of AS, however it should be noted that mechanical back pain could also ensue in advanced cases. Peripheral arthritis mostly involves in lower extremities in the form of asymmetric oligoarthritis. Enthesitis could develop in the heel, iliac crest, anterior tibial tuberosity, or anterior chest wall. As for imaging, plain radiographs are used to assess the presence or degree of sacroiliac joint and spinal involvement. Magnetic resonance imaging (MRI) is useful in detecting non-radiographic sacroiliitis, for its ability to delineate bone marrow edema. In this regard, MRI has recently been incorporated as a modality to help diagnose axial spondyloarthritis (2010 ASAS classification). Early diagnosis of AS should be based on the combination of clinical, laboratory, and imaging findings, not on solely structural changes.