Question

A 34-year-old male presents with a history of progressive lower backache and early morning stiffness for the past 6 months. His symptoms are more severe in the morning and improve on exercise. He is a known case of ulcerative colitis an x-ray of his lumbar spine is taken and is given below. What is the most likely diagnosis?

• A. Pott’s spine
• B. Psoriasis arthritis
• C. Ankylosing spondylitis
• D. Rheumatoid arthritis

Hint:

Ankylosing spondylitis is often associated with inflammatory bowel disease like ulcerative colitis. It typically causes morning stiffness and pain that improves with activity, and x-rays may show bamboo spine.

Answer 1

The Correct Option is C

Pott’s spine: This is an infection of the spine, typically caused by tuberculosis. It causes vertebral collapse, but the patient's history of inflammatory back pain and early morning stiffness suggests a different diagnosis.
Psoriasis arthritis: This is an inflammatory joint disease that is often associated with psoriasis. While it can affect the spine, the patient’s symptoms of progressive backache with improvement on exercise are more characteristic of ankylosing spondylitis rather than psoriasis arthritis.
Ankylosing spondylitis: This is the correct answer. Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the sacroiliac joints and spine. It often presents with early morning stiffness that improves with exercise, as in this patient. The presence of ulcerative colitis, a known association with AS, further supports this diagnosis. The x-ray likely shows bamboo spine, which is characteristic of AS.
Rheumatoid arthritis: This is a systemic autoimmune disorder that primarily affects peripheral joints. While it can cause some axial involvement, it is less likely to cause the characteristic morning stiffness and exercise improvement seen in ankylosing spondylitis. Thus, the correct answer is Ankylosing spondylitis (3), as it matches both the clinical presentation and the patient's history of ulcerative colitis.