A painful, inflammatory disorder mostly affecting the spine is called ankylosing spondylitis (AS). New research shows that early diagnosis is important to prevent permanent deformities. If offered early enough, patient education and physical therapy can make a difference.

Early diagnosis can be difficult. In this report, rheumatologists offer some helpful advice to doctors about making an early diagnosis of AS. Early disease can be recognized by spinal pain and stiffness. The patient also reports fatigue. All of these symptoms are present in early adulthood. Some patients recall similar symptoms in childhood.

Standard methods of diagnosis may miss early AS. Early changes are seen on special MRIs. The radiologist will see cartilage changes, intra-articular inflammation, and bone marrow edema.

X-rays are still taken first. X-ray findings along with signs of inflammatory back pain guide the physician in ordering the more expensive MRIs. Signs of inflammatory back pain include:

Symptoms improve with movement and exercise

The authors advise physicians to look for other clues to the early diagnosis of AS. These may include buttock pain on one side. Neck or upper back pain and limited low back motion. Decreased chest expansion is another important finding. Lab tests are not usually diagnostic but may be helpful.

Kara Prescott, MD, and Joel D. Taurog, MD. Ankylosing Spondylitis: The Difficulty and Importance of Early Diagnosis. In The Journal of Musculoskeletal Medicine. April 2007. Vol. 24. No. 4. Pp. 163-173.

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