Clinical quiz

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A 38-year-old lady was referred to the rheumatology unit for recurrent bilateral uveitis. She was found to have HLA-B27 positivity. Further, history showed that she was suffering from persistent lower back pain for 1 year, readily relieved by Diclofenac. There was also nocturnal pain. Radiograph of lumbar-sacral (LS) spine was normal. The C-reactive protein (CRP) level was < 0.35 mg/dl, the erythrocyte sedimentation rate (ESR) was 22 mm/hr. There was no peripheral arthritis. Magnetic Resonance Imaging (MRI) of LS spine and sacroiliac (SI) joints were performed (T1+T2 STIR).

Question 1.

Was she suffering from Spondyloarthritis (SpA)?

Question 2.

What was the cause of her back pain?

Answers

Question 1.

The patient fulfilled the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial Spondyloarthritis. (HLA-B27, uveitis, good response to NSAID).

Question 2.

T2 STIR image showed no inflammation. There were degenerative disc changes at L4/5 associated with annular tear (red arrow: globular line with increased signal intensity), which could account for her lower back pain.

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