Physical examination of patient with SpA must be focused on the active and passive ROM of spine and its peripheral joints, sacroiliac joints, and peripheral enthesitis which peresented as

swelling and tenderness on tendons.

• In early onset of disease evidence of sacroiliitis, limited ROM, and tenderness of sacroiliac joint can be observed.
• limitation of ROM of spine can be measured by Schober test.
  • Schober test can be perform by marking of 5th lumbar spinal process and again marking of 10cm from it in cephalic direction, when patient is standing; then asking from patient to flex and remeasuring distance between two marked points. normal flexion must be at least 5cm, if not the test result is positive.
• In late stages, the difference of minimal and maximal chest diameter can be less than 3cm.

• Approximately one third of patients with SpA experience peripheral enthesitis, which are painful and tender to palpation. The most common site of enthesitis is Calcaneus bone at the insertion of Achilles tendon and at the insertion of plantar fascia.
• Involvement of hip joints are more frequently seen after 10 years of disease onset, and also it is bilateral. Other joints involvement are included:
  • Temporomandibular joint
  • Costosternal junction
  • Costovertebral junction
  • Symphis pubis
  • Manubriosternal
  • Shoulder girdle
    • Glenohumeral
    • Acromioclavicular
    • Sternoclavicular

In patients with SpA extra articular manifestations must be considered and screening by performing specific examination is important, extra articular involvement are included:

• GI disease
  • Crohn’s disease
  • Ulcerative colitis
• Renal disease
• Uveitis
• Neurologic disorder
• Pulmonary disease