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
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
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Think about the seronegative spondyloarthropathy in young males causing bamboo spine and anterior uveitis.
Updated On: Jun 23, 2026
- Rheumatoid arthritis
- Ankylosing spondylitis
- Paget's disease
- Osteopetrosis
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The Correct Option is B
Solution and Explanation
Step 1: Analyse the clinical features.
Young male (26 years), chronic backache, morning stiffness, reduced chest expansion, and reddening of eyes (anterior uveitis / iritis). The X-ray shows features consistent with sacroiliitis and bamboo spine.
Step 2: Recognise ankylosing spondylitis (AS).
AS is a chronic seronegative spondyloarthropathy predominantly affecting young males (HLA-B27 positive). Classic features: inflammatory low back pain (worse at rest, improves with exercise), morning stiffness, reduced chest expansion (costovertebral joint involvement), anterior uveitis (reddening of eyes), and radiological bamboo spine (syndesmophytes causing vertebral fusion).
Step 3: Explain the X-ray.
Bamboo spine appearance on X-ray: vertebral bodies fused by syndesmophytes (ossification of outer annulus fibrosus) giving a continuous column resembling bamboo. Sacroiliac joint sclerosis and fusion are the earliest radiological finding.
Step 4: Eliminate distractors.
Rheumatoid arthritis: affects peripheral joints (symmetric small joints), females more, morning stiffness but involves wrists/hands, not typically causing bamboo spine.
Paget's disease: disease of the elderly with bone remodelling, coarse trabecular pattern, elevated ALP.
Osteopetrosis: marble bone disease, dense bones on X-ray, childhood onset.
Young male + inflammatory backache + morning stiffness + reduced chest expansion + uveitis + bamboo spine = Ankylosing spondylitis.
Young male (26 years), chronic backache, morning stiffness, reduced chest expansion, and reddening of eyes (anterior uveitis / iritis). The X-ray shows features consistent with sacroiliitis and bamboo spine.
Step 2: Recognise ankylosing spondylitis (AS).
AS is a chronic seronegative spondyloarthropathy predominantly affecting young males (HLA-B27 positive). Classic features: inflammatory low back pain (worse at rest, improves with exercise), morning stiffness, reduced chest expansion (costovertebral joint involvement), anterior uveitis (reddening of eyes), and radiological bamboo spine (syndesmophytes causing vertebral fusion).
Step 3: Explain the X-ray.
Bamboo spine appearance on X-ray: vertebral bodies fused by syndesmophytes (ossification of outer annulus fibrosus) giving a continuous column resembling bamboo. Sacroiliac joint sclerosis and fusion are the earliest radiological finding.
Step 4: Eliminate distractors.
Rheumatoid arthritis: affects peripheral joints (symmetric small joints), females more, morning stiffness but involves wrists/hands, not typically causing bamboo spine.
Paget's disease: disease of the elderly with bone remodelling, coarse trabecular pattern, elevated ALP.
Osteopetrosis: marble bone disease, dense bones on X-ray, childhood onset.
Young male + inflammatory backache + morning stiffness + reduced chest expansion + uveitis + bamboo spine = Ankylosing spondylitis.
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