Question

A 26 years old male with backache, morning stiffness, chest expansion and reddening of eyes with an X-ray presented in OPD. Most likely diagnosis for this patient is

• A. Rheumatoid arthritis
• B. Ankylosing spondylitis
• C. Paget's disease
• D. Osteopetrosis

Hint:

Think about the seronegative spondyloarthropathy in young males causing bamboo spine and anterior uveitis.

Answer 1

The Correct Option is B

Diagnosis: Ankylosing Spondylitis (AS)

Key diagnostic criteria (Modified New York Criteria):
Clinical: (1) Low back pain >3 months improving with exercise, (2) Limited lumbar spine movement, (3) Limited chest expansion
Radiological: Sacroiliitis grade 2 bilateral or grade 3-4 unilateral

Extraarticular manifestations of AS:
- Eyes: Anterior uveitis (most common -- 25-30% of patients)
- Heart: Aortic regurgitation, conduction defects
- Lungs: Upper lobe fibrosis
- Kidneys: IgA nephropathy, amyloidosis

Radiological hallmarks:
- Bamboo spine: flowing syndesmophytes fusing vertebrae
- Romanus lesion: shiny corner sign -- inflammatory lesion at vertebral corner
- Trolley-track sign: on AP view of lumbar spine

HLA association: HLA-B27 (positive in ~95% of AS patients)

Treatment: NSAIDs first line; anti-TNF biologics for refractory cases

\[\boxed{\text{Ankylosing Spondylitis}}\]