Ankylosing spondylitis is suspected of:

• Disease history

  • "Inflammatory back pain"(Gradual start before 40-45's age, duration at least 3 months, better of physical activity, nightly pain)
  • Family disposition (First row family = parents, siblings, children)
    • Known HLA-B27 +
    • Ankylosing spondylitis?
  • Eye manifestations (Uveitis / Iridocyclitis)
  • Peripheral arthritis (hips / knees)
  • Tendinitis (entesitis)
    • Achilles tendon
    • Plantar facie
  • Psoriasis (disposable factor for axial psoriasis arthritis)
    • Extensor side of elbows and knees
    • Hairline and scalp
    • At navel and anus
    • Nails
  • Inflammatory bowel disease (Ulcerative colitis / Crohn's disease) is disposable (Blood and mucus in stools, abdominal pain)
  • Heart or lung disease

• Clinical examination

  • Posture
    • Increased thoracic kyphosis
    • Flattened lumbar lordose
    • Flexed (bent) hip joint
  • Movement (all three planes: extension, flexion, lateral flexion) in the neck (cervical colum), thoracic column (thoracic columnar, thoracic excursion less than 2,5cm in 4. Intercostal space) and lumbar (lumbar columnar)
  • Distance between the head (occiput) and a wall when standing as close to the wall as possible with the entire back
  • Schober's test of the lower back
  • Finger-floor distance by forward bending
  • The circumference of the thorax at maximum in and out (thoracic excursion)
  • Arthritis of knees, Baker's cyst in knee hase (popliteal)
  • Movement of the hips
    • Hip-arthritis (reduced internal rotation)
  • Pain in provocation tests against sacroiliac joints
  • Achilles tendons and plantar facies (entesopathy)
  • Eyes: Uveitis-sequelae
  • Auscultation of the heart (heart rhythm disorders, aortic valve insufficiency)
  • Urine: proteinuria by AA-amyloidosis (Secondary due to prolonged illness)

• Radiological examinations

  • MRI or CT of sacroiliac joints
  • X-ray or MRI examination of thoracic-lumbar transition
    • Initial ankylosis or signs of inflammation?

• Blood tests

  • CRP elevated in most cases
  • HLA B27 + (genetic factor) exists in excess of 95% (8-10% of normal Norwegian population)

The referral

• In Oslo there is a distribution of functions within rheumatology. Patients with Ankylosing spondylitis should be referred Diakonhjemmet hospital, whereas connective tissue and systemic vasculitis will be assessed at Oslo University Hospital, Rikshospitalet
• Norwegian Directorate of Health (Supervisor for referrals)

Bekhterev's disease, BINDEVEVSSYKDOMMER.no

• Bindevevssykdommer.no
• Vaskulitt.no