A 26-year-old Italian-American man comes to your office for the evaluation of low back pain. He has had this pain for the last eight months, and it is progressively getting worse. The pain is worse in the morning and gets better as the day progresses. He denies any history of trauma in the past. He works as a chef at a local restaurant. His father and uncles also have "back problems." His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion. The rest of his physical and musculoskeletal examination is unremarkable. Which of the following conditions is associated with the patient's diagnosis?

Question

A 26-year-old Italian-American man comes to your office for the evaluation of low back pain.  He has had this pain for the last eight months, and it is progressively getting worse.  The pain is worse in the morning and gets better as the day progresses.  He denies any history of trauma in the past.  He works as a chef at a local restaurant.  His father and uncles also have "back problems."  His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion.  The rest of his physical and musculoskeletal examination is unremarkable. Which of the following conditions is associated with the patient's diagnosis?

Quizplus · Accepted Answer

Explanation: Once a diagnosis of ankylosing spondylitis is being considered, it is important to search for concurrent extraarticular manifestations. Although they are usually asymptomatic in the initial stages, many patients have restrictive lung disease due to the limited costovertebral joint motion and development of apical pulmonary fibrosis. It is important to counsel such patients regarding smoking cessation to prevent early deterioration of lung function. (Choice B) Ocular manifestations with AS include acute anterior uveitis, cataracts, and cystoid macular edema. Uveitis presents with acute onset unilateral eye pain, photophobia, and blurring of vision. It is sometimes the initial presentation of ankylosing spondylitis. (Choice C) The most common valvular abnormalities associated with ankylosing spondylitis include aortic regurgitation and mitral valve prolapse. The incidence of coarctation of the aorta and septal defects is not increased in these patients. (Choice D) There is an increased prevalence of varicocele, not testicular cancer, in these patients. (Choice E) The gastrointestinal manifestations are nonspecific ileal and colonic mucosal ulcerations. Some other extraarticular features include atlanto-axial subluxation causing spinal cord compression, cauda equina syndrome, IgA nephropathy, and secondary amyloidosis presenting as nephrotic syndrome. Educational objective: The most common and important extraarticular manifestations of ankylosing spondylitis are acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy, and restrictive lung disease.

A 26-Year-Old Italian-American Man Comes to Your Office for the Evaluation