Spondyloarthritides (SpAs) are a group of diseases with overlapping symptoms which include ankylosing spondylitis, psoriatic arthritis, undifferentiated spondyloarthritis and enteropathic arthritis. Here, we are discussing Ankylosing spondylitis (AS) in depth, as it often presents as pelvic pain in women(1).
Ankylosing spondylitis is an inflammatory disease of the axial skeleton and peripheral joints. This disease process erodes fibrocartilage, hyaline cartilage, and bone, leading to abnormality of vertebral bodies. Ankylosing spondylitis almost always involves the sacroiliac joints(2).
Although back pain and spine involvement are common features of AS, diagnoses are often delayed due to the lack of specific diagnostic indices. The variable presentation and course of disease between men and women also contribute to this delay(1).
Typical onset in women is before the age of 30 with insidious symptoms of pain and stiffness lasting more then three months. Back pain is typically the first presenting symptom in both men and women. Women may also present with knee pain, neck pain, hip pain and buttock pain. Fatigue, stiffness, loss of appetite, fever and pain with pressure tend to be more prevalent in women then men with AS. Women with AS will also complain of prolonged morning stiffness, especially in the neck and upper back. Pain can cause patients to move more in attempt to ease symptoms, or move less to avoid exacerbation. Often, the type of achy or sharp pain is confused with sciatica. Sacroilitis is often the earliest feature seen on x-ray(1).
- Intermittent low back pain; nontraumatic
- SI tenderness
- Spasm of paravertebral muscles
- Low grade fever
- Weight loss
- Constant low back pain
- Loss of lumbar lordosis
- Immobility and fusion of SI and spine
- Muscle wasting in shoulder and pelvic girdles
- Arthritis in peripheral joints
- Hip flexion in standing
- Cauda equina syndrome (loss of sensation in lower extremities; bowel or bladder changes; perineal pain or loss of sensation; muscle weakness/atrophy
- Inflammation of the iris(3)
- Decreased mobility in anteroposterior and lateral planes are symmetrical with a reduction in lumbar flexion(3)
- Schober test used to confirm reduction in spinal motion associated with AS
this mark, and another, second, finger, ~10 cm above this mark. The patient is asked to touch his/her toes. The
distance between the two fingers of the examiner increases. If there is a restriction, the lumbar flexion of the
patient reduces this increase; if the distance increases less than 5cm, this is an indication that the flexion of the
lower back is limited(3)
- SI joint may not be tender to palpation(1)
- Rigid spine and loss of lumbar lordosis as disease progresses(1)
- Appearance of “bamboo spine” described as a locked position of upright or stooped posture(3)