Ankylosing spondylitis: Diagnosis in sub-saharan african setting

Abstract

Background: Ankylosing spondylitis is a subset of spondyloarthritis, characterized by chronic inflammatory back pain in adolescents or young adults. ‘Imaging arm’ of ASAS classification criteria established ankylosing spondylitis as radiographic sacroiliitis. Case presentation: A 29-year-old man presented to university of Gondar hospital, Northwest Ethiopia with inflammatory back pain of 15 years duration. Radiographic imaging revealed grade 3 sacroiliitis (left sacroiliac joint ankylosis and contralateral joint space narrowing and erosions). Other supporting clinical findings were peripheral arthritis, anterior uveitis, elevated ESR, and family history of inflammatory back pain.In sum, ‘imaging arm’ of ASAS classification criteria established radiographic axial spondyloarthritis and modified New York diagnostic criteria diagnosed ankylosing spondylitis.He had physical disability with BASFI score of 5/10 on initial evaluation. He was treated with topical steroid eye drops for uveitis and oral NSAIDs for spondyloarthritis. Physical therapy was initiated as rehabilitative measure. He got symptomatic benefit with above therapeutic regimen. He waslinked to Chronic Illness Care Clinicand Ophthalmology Clinic of the hospital for follow-up. Conclusion: Ankylosing spondylitis had significant impact on physical function and quality of life in African setting.Possible reasons could be late diagnosis due todelayed radiographic evidences and limited access to magnetic resonance imaging, inadequate therapy with available NSAIDs and unavailability of biologic DMARDs.