Ankylising Spondylitis (AS). Prepared by Dr Gabriel Castro.

        34 y/o man with frequent pain and stiffness in the lower back. In recent weeks presented with mild fever and general discomfort. CBC did not show any abnormalities and reumatic factor was negative. 99mTc-MDP scintigraphy shows increased radiotracer uptake in the inferior aspect of sacroiliac joints and also in both achromioclavicular, right sternoclavicular, costovertebral unions and knees. Sacroiliac Index was, right side: 2.3 and left side: 2.8. These findings jointly with clinical symptoms led to the diagnosis of  AS. AS is a common chronic inflammatory disease . Onset is typically in the third decade of life and more frequent in males.The primary pathologic sites are the entheses (the sites of bony insertion of ligaments and tendons); the axial skeleton, including the sacroiliac joints; the limb joints; and some nonarticular structures, such as the gut, skin, eye, and aortic valve  could also be involved (1). The scintigraphic appearances of  AS leads  to diagnosis before the development of radiographic changes and avoid confusion with other pathologies (2).

References:

1) Update on spondyloarthropathies. Ann Intern Med. 2002 Jun 18;136(12):896-907.

2) 99mTc-MDP scintigraphy in ankylosing spondylitis. Clin Radiol. 1993 Dec;48(6):392-7.

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