Question

A 26 years old male with backache, morning stiffness, chest expansion and reddening of eyes with an X-ray presented in OPD. Most likely diagnosis for this patient is

[X-ray shows bamboo spine appearance with sacroiliac joint involvement]

• A. Rheumatoid arthritis
• B. Ankylosing spondylitis
• C. Paget's disease
• D. Osteopetrosis

Hint:

Bamboo spine on X-ray with morning stiffness and uveitis in a young male is pathognomonic of a seronegative spondyloarthropathy.

Answer 1

The Correct Option is B

Step 1: Identify key clinical features. The patient is a 26-year-old male with:
- Backache and morning stiffness (inflammatory back pain)
- Reduced chest expansion (due to costovertebral joint involvement)
- Reddening of eyes (anterior uveitis / iritis)
- X-ray showing bamboo spine appearance

Step 2: Understand Ankylosing Spondylitis (AS). AS is a chronic seronegative spondyloarthropathy predominantly affecting young males. It begins with sacroiliitis and progressively involves the entire spine. The hallmark X-ray finding is the bamboo spine (syndesmophytes bridging vertebral bodies giving a bamboo-like appearance on AP view).

Step 3: Extra-articular features of AS. Anterior uveitis (iritis) causing reddening of the eye is the most common extra-articular feature of AS (occurs in 25-30% of cases). Reduced chest expansion occurs when costovertebral joints are affected (normal chest expansion is > 5 cm; in AS it may be < 2.5 cm). Other features include aortitis, pulmonary apical fibrosis, and cauda equina syndrome.

Step 4: Eliminate other options. Rheumatoid arthritis is a symmetric peripheral joint disease predominantly affecting women; the spine involvement (if any) is in the cervical region, not the lumbar spine with sacroiliitis. Paget's disease occurs in older patients with bone overgrowth. Osteopetrosis is a congenital disorder with uniformly dense bones, not an inflammatory arthropathy.