A 27-year-old man presents with 6 months of worsening low back pain. The pain is worse in the morning and associated with morning “stiffness” that improves with walking and exercise. The patient feels well and denies any systemic symptoms. Physical examination reveals limited range of motion on forward flexion of her lower back. X-ray reveals the presence of a “bamboo spine.
Which of the following is the most common extra-articular manifestation of this patient’s condition?
A. Aortic valve insufficiencyAnterior uveitis. The patient in this question is presenting with signs, symptoms, and radiologic findings consistent with a diagnosis of ankylosing spondylitis (AS). AS has a strong association with HLA-B27. The most common extra-articular manifestation of AS is anterior uveitis: inflammation in the anterior chamber of the eye. This can cause erythema, pain, and photophobia. The reason for this association is that both AS and uveitis share an inheritance with the HLA-B27 antigen. (A, B) Both aortic valve insufficiency and lung fibrosis are less commonly associated with AS. (D) Oral ulcers are associated with systemic lupus erythematosus (SLE) and Crohn disease, but not associated with AS.