Question:medium
A 50 year old male presents with backache and morning stiffness, red eye, and ankle swelling. A pelvic X-ray is shown. What is the most likely diagnosis?
A 50 year old male presents with backache and morning stiffness, red eye, and ankle swelling. A pelvic X-ray is shown. What is the most likely diagnosis?
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Inflammatory backache with red eye and ankle swelling in a young-to-middle-aged male points to a seronegative spondyloarthropathy.
Updated On: Jun 23, 2026
- Ankylosing Spondylitis
- Healed TB spine
- Paget's disease
- Osteopetrosis
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The Correct Option is A
Solution and Explanation
Diagnosis: Ankylosing Spondylitis (AS)
The classic triad in this question -- inflammatory backache + morning stiffness + red eye (anterior uveitis) + ankle swelling (enthesitis) -- is pathognomonic of Ankylosing Spondylitis.
Key facts about AS:
- Seronegative spondyloarthropathy strongly associated with HLA-B27
- Predominantly affects young males (onset typically under 40 years)
- Inflammatory back pain: worse at rest, improves with activity, associated with morning stiffness > 30 minutes
- Extra-articular features: anterior uveitis (25--30%), enthesitis, peripheral arthritis, aortic regurgitation, apical pulmonary fibrosis
Radiographic features on pelvic X-ray:
- Sacroiliitis: subchondral sclerosis, erosions, pseudo-widening, then ankylosis of SI joints
- Spine: vertebral squaring, Romanus lesion (shiny corner sign), syndesmophytes leading to bamboo spine
- Dagger spine: linear ossification of interspinous ligaments on AP view
Treatment: NSAIDs first-line; biologics (anti-TNF agents) for refractory disease
\[\boxed{\text{Ankylosing Spondylitis}}\]
The classic triad in this question -- inflammatory backache + morning stiffness + red eye (anterior uveitis) + ankle swelling (enthesitis) -- is pathognomonic of Ankylosing Spondylitis.
Key facts about AS:
- Seronegative spondyloarthropathy strongly associated with HLA-B27
- Predominantly affects young males (onset typically under 40 years)
- Inflammatory back pain: worse at rest, improves with activity, associated with morning stiffness > 30 minutes
- Extra-articular features: anterior uveitis (25--30%), enthesitis, peripheral arthritis, aortic regurgitation, apical pulmonary fibrosis
Radiographic features on pelvic X-ray:
- Sacroiliitis: subchondral sclerosis, erosions, pseudo-widening, then ankylosis of SI joints
- Spine: vertebral squaring, Romanus lesion (shiny corner sign), syndesmophytes leading to bamboo spine
- Dagger spine: linear ossification of interspinous ligaments on AP view
Treatment: NSAIDs first-line; biologics (anti-TNF agents) for refractory disease
\[\boxed{\text{Ankylosing Spondylitis}}\]
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