Valerie Rome, BA
Third Year Medical Student
Rowan-Virtua SOM
Voorhees, New Jersey, United States
Sahba Oboudiyat, DO, FAAPMR
Assistant Professor of Clinical Physical Medicine and Rehabilitation
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Ankylosing Spondylitis
Case Description:
A 27-year-old female presented with a year-long history of right-sided sacroiliac (SI) joint and gluteal pain, with no previous trauma. Despite previous trials of conservative therapies including physical therapy and SI joint injections, the pain persisted. Anti-inflammatory medications provided minimal relief. Family history was notable for an aunt with rheumatoid arthritis. Initial imaging with MRI of lumbar spine was normal. Rheumatoid workup along with tick-borne illness titers, to rule out any other infection or chronic issues, was negative. On physical examination, the patient had tenderness with palpation and reproduction of pain with FABER test at the right SI joint. Follow-up imaging with MRI of pelvis showed moderate to severe asymmetric right sacroiliitis. HLA-B27 testing revealed a positive result. The patient was eventually diagnosed with ankylosing spondylitis (AS).
Discussions:
Ankylosing spondylitis is a seronegative spondyloarthropathy resulting in chronic inflammation of the axial skeleton, especially the SI joints. It frequently manifests insidiously as lower back discomfort, which might be misconstrued for various musculoskeletal diseases, as in this example. The delay in diagnosis, despite persistent symptoms, emphasizes the importance of a full evaluation, including proper imaging and HLA-B27 testing, particularly in young patients with chronic SI joint discomfort and a family history of autoimmune disease. In this case, patient symptoms, MRI results and positive HLA-B27 allele validated the diagnosis. Although there is no cure for AS, regular physiotherapy and pharmacotherapy with TNF-α inhibitors can slow disease progression and control symptoms.
Conclusions:
This case highlights the necessity of considering ankylosing spondylitis in the differential diagnosis in young individuals who have chronic SI joint discomfort and a family history of autoimmune disease. Early identification through adequate imaging and lab tests is critical for starting therapy to prevent disease progression and improve patient quality of life.
