General
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• Chronic inflammatory disease of axial joints, especially sacroiliac
• Affects teenage boys, 90% are HLA-B27 positive
• M:F: 2-3:1

Pathophysiology
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• Typically involves sacroiliac joints and slowly ascends
• Chronic synovitis destroys articular cartilage and causes bony ankylosis
• Inflammation of tendinoligamentous insertion sites cause osteophytes
• CD3+ T cells and CD68+ macrophages are main inflammatory cells

Clinical features
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• Symptoms: low back pain that gets progressively worse
• Reactive bone formation may be seen in ring apophysis with erosions of margins
• Calcification of posterior longitudional ligament is seen
• In later stages, spine appears fused with fixed kyphosis (Bamboo spine)
• Complications: uveitis, aortitis, amyloidosis

Diagrams
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Ankylosing spondylitis

Case reports
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• 30 year old woman with coexisting ankylosing spondylitis and rheumatoid arthritis (Chin Med J (Engl) 2011;124:3430)
• 47 year old man with coexisting CML (Tunis Med 2012;90:901)
• 55 year old man with associated foraminal synovial cyst (J Korean Neurosurg Soc 2011;50:54)
• 57 year old man with 30 year history and recent onset cauda equina syndrome and dural ectasia (Br J Radiol 2011;84:e123)

Clinical images
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Anterior flexion

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