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Everyday many patients visiting us with the only complaints of back pain. If any young patient having sacro ilitis, be cautious. it may be the earliest symptom of Ankylosing spondylitis. Radiological

Everyday many patients visiting us with the only complaints of back pain. If any young patient having sacro ilitis, be cautious. it may be the earliest symptom of Ankylosing spondylitis. Radiological diagnosis is impossible in early stage and bone scan, MRI is out of reach from common patients. if fusion will get started it cant be revert by any means. only thing we can do to prevent further progression of the disease is to advice him life long exercise.

Comment by Ankala Subbarao on November 1, 2010 at 9:32am: You are right. A high index of suspicion for Ank Spond must be there in any young male pt presenting with unexplained backache.
Clinical points in favour are:
-- Pain at rest, improving with exercise
--Tenderness at Enthesis (tendon insertions into bone)
--Raised ESR and +ve CRP
MRI and Bone changes may take years to develop.

Comment by Ankala Subbarao on November 1, 2010 at 9:37am: Another important DD especially in our parts is Fluorosis.
In certain pockets of Andhra Pradesh (Darsi, Podili in Prakasam Dts and JR Gudem and Vemagiri in EG Dts, Devarapalli in WG Dts), the bore water contains lot of salts including fluoride, Ca++, Mg++ and Strontium. This problem is still not well defined.
In these areas, informed patients take lots of pains to carry water from the river or demineralised water.
Fluorosis mimicks Ank spond. The telltale dental signs are diagnostic.

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