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).
Was she suffering from Spondyloarthritis (SpA)?
What was the cause of her back pain?
The patient fulfilled the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial Spondyloarthritis. (HLA-B27, uveitis, good response to NSAID).
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.