Diagnosis and management of ankylosing spondylitis

The idea that ankylosing spondylitis is a separate entity from rheumatoid arthritis has recently been strengthened by the discovery that the majority of individuals suffering from ankylosing spondylitis exhibit the histocompatibility antigen HLA B27. Inflammation of the sacroiliacs must be present for a diagnosis of ankylosing spondylitis to be made. Radiological interpretation of sacroiliac films may be difficult. In patients with normal or equivocal X-rays of the sacroiliacs, radioisotope scanning of the sacroiliac joint may confirm diagnosis. Although the articular features of ankylosing spondylitis are well known, a variety of systemic complications may be attributed to some other cause. The principles of management require a precise diagnosis, control of pain and maintenance of a good functional state by means of physiotherapy. The majority of patients with ankylosing spondylitis respond well to therapy.