Articular manifestations
The articular manifestations of ankylosing spondylitis include:
- backache and stiffness usually worse after inactivity or on waking in the morning
- back pain is usually initially in the lumbar region and then progresses to the thoracic region pain
- 10% of cases have swollen and tender peripheral joints
- all movements of the spine are reduced, especially extension, resulting in:
- failure to obliterate lumbar lordosis on forward flexion
- chest expansion of less than 5 cm
- complete rigidity due to ankylosis
- painful heels and tenderness at the site of insertion of the achilles tendon - achilles tendinitis
- pain over the iliac crest
- atlanto-axial subluxation
- osteoporosis
- in children a lower limb oligoarthritis usually precedes spinal involvement
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