Treatment Guideline Chart
Spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases characterized by spinal & joint oligoarthritis, enthesitis, and sometimes mucocutaneous, ocular and/or cardiac manifestations.
Ankylosing spondylitis is a prototype of spondyloarthritis, particularly of the axial form.
Diagnosis of ankylosing spondylitis is definite if any of the radiological criterion is associated with at least one clinical criterion.

Ankylosing%20spondylitis Signs and Symptoms


  • Axial spondyloarthritis (SpA) refers to a group of chronic inflammatory rheumatic diseases characterized by spinal and joint oligoarthritis, enthesitis, and sometimes, mucocutaneous, ocular, and/or cardiac manifestations 
    • SpA is characterized by articular inflammation, erosion and new bone formation at peripheral and axial sites
      • Strong tendency to affect the spine, especially the sacroiliac joints
  • Divided into two subgroups, depending on the presence of sacroiliitis on plain radiography:
    • Ankylosing spondylitis (AS) or radiographic axial SpA - features sacroiliitis
    • Non-radiographic axial SpA - absence of sacroiliitis


  • AS is a prototype of SpA, particularly of the axial form of SpA
  • Most common inflammatory disorder involving the axial skeleton
  • Predominantly seen in male individuals

Signs and Symptoms

Main Clinical Manifestations of Axial Spondyloarthritis

  • Inflammatory chronic back pain persisting for >3 months with four of the following characteristics:
    • Onset before 40 years of age
    • Insidious onset
    • Improves with exercise
    • Nocturnal pain with improvement upon getting up
    • Associated with morning stiffness not improved by rest
  • Synovitis
  • Peripheral arthritis
  • Ankylosis
  • Dactylitis (finger or toe inflammation resulting in a sausage appearance)
  • Inflammation of the attachments of ligaments and tendons to bones (enthesitis)
  • Extra-articular manifestations such as anterior uveitis, psoriasis, inflammatory bowel disease (IBD)

Clinical Manifestations of Ankylosing Spondylitis

  • Inflammatory chronic back pain and stiffness
  • Chest pain/costochondritis
  • Alternate buttock pain
  • Acute anterior uveitis
  • Asymmetric oligoarthritis predominantly of lower limbs
  • Enthesitis (eg heel, plantar)
  • Radiographic sacroiliitis
  • Positive family history of AS, chronic IBD or psoriasis

Clinical Manifestations of Non-Radiographic Axial Spondyloarthritis

  • Vertebrae structural abnormalities are less severe in non-radiographic axial SpA than advanced AS
  • There is a higher prevalence of occurrence of enthesitis in non-radiographic axial SpA than AS
  • Dactylitis 
  • Asymptomatic ileac and colonic mucosal ulcerations (occur in 50% of patients)
  • Psoriasis (occurs in 10% of patients)
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