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A case of axial undifferentiated spondyloarthritis diagnosis and management

Nature Clinical Practice Rheumatology volume 3, pages 298–303 (2007)Cite this article

Abstract

Background A 32-year-old white man presented with features of inflammatory back pain, including awakening at night and morning stiffness. He had acute back pain 4 years earlier as a result of a herniated lumbar disc.

Investigations The orthopedic consultation included tests for neurologic deficits; a Lasègue test; a finger-to-floor distance test; X-rays of the lumbar spine; and MRI of the lumbar spine. The rheumatologic consultation included recordal of clinical history and family history; physical examination, including a Schober's test, lateral spine flexion, chest expansion, cervical rotation, and tragus-to-wall distance; blood tests, including genotyping for human leukocyte antigen B27 positivity, and measurements of C-reactive protein level and erythrocyte sedimentation rate; MRI of the sacroiliac joints with use of short tau inversion recovery sequences; and measurement of the Bath Ankylosing Spondylitis Disease Activity Index and the Bath Ankylosing Spondylitis Functional Index.

Diagnosis Axial undifferentiated spondyloarthritis.

Management NSAIDs and physiotherapy.

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Figure 1: MRI with short tau inversion recovery sequence of sacroiliac joints
Figure 2: Calculating the probability of a diagnosis of axial spondyloarthritis using the LR product approach
Figure 3: Calculating the probability of a diagnosis of axial spondyloarthritis using a diagnostic algorithm

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Acknowledgements

We thank the German Ministry of Education and Research (BMBF) for financial support of our work in early spondyloarthritis, grant number FKZ 01GI9946.

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Authors and Affiliations

  1. in the Rheumatology section of the Department of Medicine I, M Rudwaleit is a Consultant in Rheumatology and J Sieper is a Professor of Rheumatology, Charitè Universitätsmedizin, Berlin, Germany.,

    Martin Rudwaleit & Joachim Sieper

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  1. Martin Rudwaleit
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  2. Joachim Sieper
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Correspondence to Martin Rudwaleit.

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The authors declare no competing financial interests.

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Rudwaleit, M., Sieper, J. A case of axial undifferentiated spondyloarthritis diagnosis and management. Nat Rev Rheumatol 3, 298–303 (2007). https://doi.org/10.1038/ncprheum0486

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