Ankylosing spondylitis differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Ankylosing spondylitis must be differentiated from other diseases causing reactive arthritis,rheumatoid arthritis and psoriatic arthritis.
Preferred Table
| Arthritis Type | Clinical Features | Body Distribution | Key Signs | Laboratory Abnormalities | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| History of Psoriasis | Symmetric joint involvement | Asymmetric joint involvement | Enthesopathy | Dactylitis | Nail Dystrophy | Human immunodeficiency virus association | Upper extremity-hands | Lower extremity | Sacroiliac joints | Spine | Osteopenia | Joint Space | Ankylosis | Periostitis | Soft tissue swelling | ESR | Rheumatoid factor (RF) | HLA-B27 | |
| Psoriatic arthritis | + | + | ++ | + | + | + | + | +++ (DIP/PIP) | +++ | ++ (Unilateral) | ++ | – | ++ (Widening) | ++ | +++ (Fluffy) | ++ | + | – | 30-75% |
| Rheumatoid arthritis | – | ++ | + | – | – | – | – | +++ | +++ | + (Unilateral) | ++(Cervical) | +++ | +++ (Narrowing) | + | + (Linear) | +++ | +++ | +++ | 6-8% |
| Ankylosing spondylitis | – | +++ | – | + | – | – | – | + | + | +++ (Bilateral) | +++ | +++ | ++ (Narrowing) | +++ | +++ (Fluffy) | + | +++ | – | 90% |
| Reactive arthritis (Reiter’s syndrome) | – | +++ | – | + | + | – | – | ++ | +++ | ++ (Unilateral) | + | + | + (Narrowing) | – | +++ (Fluffy) | ++ | ++ | – | 75% |
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