Patient case: Ankylosing Spondylitis
A 29-year-old man presents with a 2-year history of chronic lower back pain and stiffness that has progressively worsened over time. He reports that the pain is worse in the morning and improves with physical activity but returns after periods of rest. He also experiences discomfort in his hips and occasional pain in the neck.
The patient has a family history of autoimmune disorders, and he has noticed that the stiffness is often accompanied by fatigue. On physical examination, there is reduced lumbar spine mobility, and a Schober test shows limited flexion. He has tenderness over the sacroiliac joints, and there are no signs of neurological deficits.
Given the clinical findings and symptomatology, he is suspected of having ankylosing spondylitis. Blood tests reveal a positive HLA-B27 antigen. The patient is counseled on treatment options, including nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, and he is encouraged to engage in regular exercise to maintain mobility and reduce stiffness.
a). Severe neck pain
b). Chronic lower back pain and stiffness
c). Numbness in the legs
d). Acute pain after exercise
a). Pain that worsens with activity
b). Stiffness that improves with physical activity
c). Pain that is constant throughout the day
d). Sudden onset of severe back pain
a). Positive straight leg raise test
b). Limited lumbar spine mobility and tenderness over the sacroiliac joints
c). Increased range of motion in the hip
d). Positive reflex tests in the lower extremities
a). Positive rheumatoid factor
b). Elevated C-reactive protein
c). Positive HLA-B27 antigen
d). Decreased white blood cell count
