Question:
A 32 year old male present with chronic low back pain for the past 6 months. the pain is insidious in onset version in morning and improve with moment he also reports alternating buttocks pain. What is the most likely diagnosis?
A 32 year old male present with chronic low back pain for the past 6 months. the pain is insidious in onset version in morning and improve with moment he also reports alternating buttocks pain. What is the most likely diagnosis?
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Inflammatory back pain = worse in the morning, better with exercise, insidious onset in a young person. Mechanical back pain = better in the morning, worse with exercise/exertion, often acute onset.
Updated On: Sep 3, 2026
- Ankylosing spondylitis
- Diffuse idiopathic skeletal hyperostosis
- Disc prolapse
- spondylolysthesis
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The Correct Option is A
Solution and Explanation
Concept:
The patient is a young male presenting with a classic history of inflammatory back pain, which is the hallmark of axial spondyloarthritis, specifically Ankylosing Spondylitis (AS).
Explanation:
• To differentiate inflammatory back pain (seen in autoimmune conditions) from mechanical back pain, the Assessment of SpondyloArthritis international Society (ASAS) criteria are used.
• Inflammatory back pain is characterized by:
1. Age of onset $<$ 40 years.
2. Insidious (gradual) onset.
3. Improvement with exercise/movement.
4. No improvement with rest.
5. Pain at night (with improvement upon getting up).
6. Prominent morning stiffness lasting $>$ 30 minutes.
• "Alternating buttock pain" is a highly specific symptom of sacroiliitis, indicating inflammation shifting between the left and right sacroiliac joints.
• Option (B), Diffuse Idiopathic Skeletal Hyperostosis (DISH), typically affects older individuals (usually $>$ 50 years) and causes stiffness and mechanical-like pain due to flowing osteophytes along the anterolateral spine. It does not cause sacroiliitis or alternating buttock pain.
• Option (C), Disc prolapse, causes acute, mechanical, or radicular back pain (sciatica) that worsens with movement and improves with rest.
• Option (D), Spondylolisthesis, causes mechanical back pain worsened by extension of the spine.
Final answer:
The constellation of young age, insidious onset, morning stiffness improving with movement, and alternating buttock pain fits perfectly with Ankylosing Spondylitis.
The patient is a young male presenting with a classic history of inflammatory back pain, which is the hallmark of axial spondyloarthritis, specifically Ankylosing Spondylitis (AS).
Explanation:
• To differentiate inflammatory back pain (seen in autoimmune conditions) from mechanical back pain, the Assessment of SpondyloArthritis international Society (ASAS) criteria are used.
• Inflammatory back pain is characterized by:
1. Age of onset $<$ 40 years.
2. Insidious (gradual) onset.
3. Improvement with exercise/movement.
4. No improvement with rest.
5. Pain at night (with improvement upon getting up).
6. Prominent morning stiffness lasting $>$ 30 minutes.
• "Alternating buttock pain" is a highly specific symptom of sacroiliitis, indicating inflammation shifting between the left and right sacroiliac joints.
• Option (B), Diffuse Idiopathic Skeletal Hyperostosis (DISH), typically affects older individuals (usually $>$ 50 years) and causes stiffness and mechanical-like pain due to flowing osteophytes along the anterolateral spine. It does not cause sacroiliitis or alternating buttock pain.
• Option (C), Disc prolapse, causes acute, mechanical, or radicular back pain (sciatica) that worsens with movement and improves with rest.
• Option (D), Spondylolisthesis, causes mechanical back pain worsened by extension of the spine.
Final answer:
The constellation of young age, insidious onset, morning stiffness improving with movement, and alternating buttock pain fits perfectly with Ankylosing Spondylitis.
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