• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Nov 2002; 61(Suppl 3): iii8–iii18.
PMCID: PMC1766729

Ankylosing spondylitis: an overview


Ankylosing spondylitis (AS) is a complex, potentially debilitating disease that is insidious in onset, progressing to radiological sacroiliitis over several years. Patients with symptomatic AS lose productivity owing to work disability and unemployment, have a substantial use of healthcare resources, and reduced quality of life. The pathogenesis of AS is poorly understood. However, immune mediated mechanisms involving human leucocyte antigen (HLA)-B27, inflammatory cellular infiltrates, cytokines (for example, tumour necrosis factor α and interleukin 10), and genetic and environmental factors are thought to have key roles. The detection of sacroiliitis by radiography, magnetic resonance imaging, or computed tomography in the presence of clinical manifestations is diagnostic for AS, although the presence of inflammatory back pain plus at least two other typical features of spondyloarthropathy (for example, enthesitis and uveitis) is highly predictive of early AS. Non-steroidal anti-inflammatory drugs (NSAIDs) effectively relieve inflammatory symptoms and are presently first line drug treatment. However, NSAID treatment has only a symptomatic effect and probably does not alter the disease course. For symptoms refractory to NSAIDs, second line treatments, including corticosteroids and various disease modifying antirheumatic drugs, are employed but are of limited benefit. Emerging biological therapies target the inflammatory processes underlying AS, and thus, may favourably alter the disease process, in addition to providing symptom relief.

Full Text

The Full Text of this article is available as a PDF (269K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998 Jan;41(1):58–67. [PubMed]
  • Fellmann J. Wege und Irrwege in der Geschichte der Spondylitis ankylosans. Schweiz Rundsch Med Prax. 1991 May 21;80(21):576–579. [PubMed]
  • Arnett FC. Ankylosing spondylitis 1992: from Connor to transgenes. J Ir Coll Physicians Surg. 1993 Jul;22(3):207–211. [PubMed]
  • Moll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore) 1974 Sep;53(5):343–364. [PubMed]
  • Arnett FC. Seronegative spondylarthropathies. Bull Rheum Dis. 1987;37(1):1–12. [PubMed]
  • Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. [PubMed]
  • Ahvonen P, Sievers K, Aho K. Arthritis associated with Yersinia enterocolitica infection. Acta Rheumatol Scand. 1969;15(3):232–253. [PubMed]
  • Schlosstein L, Terasaki PI, Bluestone R, Pearson CM. High association of an HL-A antigen, W27, with ankylosing spondylitis. N Engl J Med. 1973 Apr 5;288(14):704–706. [PubMed]
  • Brewerton DA, Caffrey M, Nicholls A, Walters D, Oates JK, James DC. Reiter's disease and HL-A 27. Lancet. 1973 Nov 3;302(7836):996–998. [PubMed]
  • Ebringer RW, Cawdell DR, Cowling P, Ebringer A. Sequential studies in ankylosing spondylitis. Association of Klebsiella pneumoniae with active disease. Ann Rheum Dis. 1978 Apr;37(2):146–151. [PMC free article] [PubMed]
  • Mäki-Ikola O, Lehtinen K, Granfors K, Vainionpä R, Toivanen P. Bacterial antibodies in ankylosing spondylitis. Clin Exp Immunol. 1991 Jun;84(3):472–475. [PMC free article] [PubMed]
  • Mielants H, Veys EM, Joos R, Noens L, Cuvelier C, De Vos M. HLA antigens in seronegative spondylarthropathies. Reactive arthritis and arthritis in ankylosing spondylitis: relation to gut inflammation. J Rheumatol. 1987 Jun;14(3):466–471. [PubMed]
  • Schmitt E, Rückbeil C, Wick RR. Long-term clinical investigation of patients with ankylosing spondylitis treated with 224Ra. Health Phys. 1983;44 (Suppl 1):197–202. [PubMed]
  • Wick RR, Gössner W. Follow-up study of late effects in 224Ra treated ankylosing spondylitis patients. Health Phys. 1983;44 (Suppl 1):187–195. [PubMed]
  • Smith PG, Doll R. Mortality among patients with ankylosing spondylitis after a single treatment course with x rays. Br Med J (Clin Res Ed) 1982 Feb 13;284(6314):449–460. [PMC free article] [PubMed]
  • Weiss HA, Darby SC, Doll R. Cancer mortality following X-ray treatment for ankylosing spondylitis. Int J Cancer. 1994 Nov 1;59(3):327–338. [PubMed]
  • Weiss HA, Darby SC, Fearn T, Doll R. Leukemia mortality after X-ray treatment for ankylosing spondylitis. Radiat Res. 1995 Apr;142(1):1–11. [PubMed]
  • Moreland LW, Russell AS, Paulus HE. Management of rheumatoid arthritis: the historical context. J Rheumatol. 2001 Jun;28(6):1431–1452. [PubMed]
  • Dougados M, Revel M, Khan MA. Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation. Baillieres Clin Rheumatol. 1998 Nov;12(4):717–736. [PubMed]
  • Mena HR, Willkens RF. Treatment of ankylosing spondylitis with flurbiprofen or phenylbutazone. Eur J Clin Pharmacol. 1977 Apr 20;11(4):263–266. [PubMed]
  • Van Gerwen F, Van der Korst JK, Gribnau FW. Double-blind trial of naproxen and phenylbutazone in ankylosing spondylitis. Ann Rheum Dis. 1978 Feb;37(1):85–88. [PMC free article] [PubMed]
  • Franssen MJ, Gribnau FW, van de Putte LB. A comparison of diflunisal and phenylbutazone in the treatment of ankylosing spondylitis. Clin Rheumatol. 1986 Jun;5(2):210–220. [PubMed]
  • Benjamin SB, Ishak KG, Zimmerman HJ, Grushka A. Phenylbutazone liver injury: a clinical-pathologic survey of 23 cases and review of the literature. Hepatology. 1981 May-Jun;1(3):255–263. [PubMed]
  • Inman WH. Study of fatal bone marrow depression with special reference to phenylbutazone and oxyphenbutazone. Br Med J. 1977 Jun 11;1(6075):1500–1505. [PMC free article] [PubMed]
  • Hart FD, Boardman PL. Indomethacin and phenylbutazone: a comparison. Br Med J. 1965 Nov 27;2(5473):1281–1284. [PMC free article] [PubMed]
  • Lockie LM. Tolerability and efficacy of long-term daily administration of indomethacin for moderate to severe chronic arthritic disorders. Clin Ther. 1986;8(4):398–405. [PubMed]
  • Good A, Mena H. Treatment of ankylosing spondylitis with flurbiprofen and indomethacin. Curr Med Res Opin. 1977;5(1):117–121. [PubMed]
  • Khan MA. A double blind comparison of diclofenac and indomethacin in the treatment of ankylosing spondylitis. J Rheumatol. 1987 Feb;14(1):118–123. [PubMed]
  • Bird HA, Le Gallez P, Astbury C, Looi D, Wright V. A parallel group comparison of tenoxicam and piroxicam in patients with ankylosing spondylitis. Pharmatherapeutica. 1986;4(7):457–462. [PubMed]
  • Schwarzer AC, Cohen M, Arnold MH, Kelly D, McNaught P, Brooks PM. Tenoxicam compared with diclofenac in patients with ankylosing spondylitis. Curr Med Res Opin. 1990;11(10):648–653. [PubMed]
  • Palferman TG, Webley M. A comparative study of nabumetone and indomethacin in ankylosing spondylitis. Eur J Rheumatol Inflamm. 1991;11(2):23–29. [PubMed]
  • Standel W, Josenhants G. Clinical evaluation of tenoxicam in osteoarthrosis, rheumatoid arthritis and ankylosing spondylitis. Eur J Rheumatol Inflamm. 1985;8(1):28–38. [PubMed]
  • Calin A. Clinical use of tolmetin sodium in patients with ankylosing spondylitis: a review. J Clin Pharmacol. 1983 Jul;23(7):301–308. [PubMed]
  • Lomen PL, Turner LF, Lamborn KR, Brinn EL, Sattler LP. Flurbiprofen in the treatment of ankylosing spondylitis. A comparison with phenylbutazone. Am J Med. 1986 Mar 24;80(3A):120–126. [PubMed]
  • Langman MJ, Jensen DM, Watson DJ, Harper SE, Zhao PL, Quan H, Bolognese JA, Simon TJ. Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs. JAMA. 1999 Nov 24;282(20):1929–1933. [PubMed]
  • Simon LS, Weaver AL, Graham DY, Kivitz AJ, Lipsky PE, Hubbard RC, Isakson PC, Verburg KM, Yu SS, Zhao WW, et al. Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial. JAMA. 1999 Nov 24;282(20):1921–1928. [PubMed]
  • Braun J, Bollow M, Seyrekbasan F, Häberle HJ, Eggens U, Mertz A, Distler A, Sieper J. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol. 1996 Apr;23(4):659–664. [PubMed]
  • Günaydin I, Pereira PL, Daikeler T, Mohren M, Trübenbach J, Schick F, Kanz L, Kötter I. Magnetic resonance imaging guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol. 2000 Feb;27(2):424–428. [PubMed]
  • Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996 Aug;35(8):767–770. [PubMed]
  • Peters ND, Ejstrup L. Intravenous methylprednisolone pulse therapy in ankylosing spondylitis. Scand J Rheumatol. 1992;21(3):134–138. [PubMed]
  • Taggart A, Gardiner P, McEvoy F, Hopkins R, Bird H. Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study. Arthritis Rheum. 1996 Aug;39(8):1400–1405. [PubMed]
  • Thomson GT, Thomson BR, Thomson KS, Ducharme JS. Clinical efficacy of mesalamine in the treatment of the spondyloarthropathies. J Rheumatol. 2000 Mar;27(3):714–718. [PubMed]
  • Dougados M, vam der Linden S, Leirisalo-Repo M, Huitfeldt B, Juhlin R, Veys E, Zeidler H, Kvien TK, Olivieri I, Dijkmans B, et al. Sulfasalazine in the treatment of spondylarthropathy. A randomized, multicenter, double-blind, placebo-controlled study. Arthritis Rheum. 1995 May;38(5):618–627. [PubMed]
  • Sampaio-Barros PD, Costallat LT, Bertolo MB, Neto JF, Samara AM. Methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol. 2000;29(3):160–162. [PubMed]
  • Biasi D, Carletto A, Caramaschi P, Pacor ML, Maleknia T, Bambara LM. Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clin Rheumatol. 2000;19(2):114–117. [PubMed]
  • Altan L, Bingöl U, Karakoç Y, Aydiner S, Yurtkuran M, Yurtkuran M. Clinical investigation of methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol. 2001;30(5):255–259. [PubMed]
  • Ball EJ, Khan MA. HLA-B27 polymorphism. Joint Bone Spine. 2001 Oct;68(5):378–382. [PubMed]
  • Feltkamp TE, Mardjuadi A, Huang F, Chou CT. Spondyloarthropathies in eastern Asia. Curr Opin Rheumatol. 2001 Jul;13(4):285–290. [PubMed]
  • Gonzalez-Roces S, Alvarez MV, Gonzalez S, Dieye A, Makni H, Woodfield DG, Housan L, Konenkov V, Abbadi MC, Grunnet N, et al. HLA-B27 polymorphism and worldwide susceptibility to ankylosing spondylitis. Tissue Antigens. 1997 Feb;49(2):116–123. [PubMed]
  • Madden DR, Gorga JC, Strominger JL, Wiley DC. The structure of HLA-B27 reveals nonamer self-peptides bound in an extended conformation. Nature. 1991 Sep 26;353(6342):321–325. [PubMed]
  • Jardetzky TS, Lane WS, Robinson RA, Madden DR, Wiley DC. Identification of self peptides bound to purified HLA-B27. Nature. 1991 Sep 26;353(6342):326–329. [PubMed]
  • Hammer RE, Maika SD, Richardson JA, Tang JP, Taurog JD. Spontaneous inflammatory disease in transgenic rats expressing HLA-B27 and human beta 2m: an animal model of HLA-B27-associated human disorders. Cell. 1990 Nov 30;63(5):1099–1112. [PubMed]
  • Zeidler H, Mau W, Khan MA. Undifferentiated spondyloarthropathies. Rheum Dis Clin North Am. 1992 Feb;18(1):187–202. [PubMed]
  • Stafford L, Youssef PP. Spondyloarthropathies: an overview. Intern Med J. 2002 Jan-Feb;32(1-2):40–46. [PubMed]
  • Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, Deicher H. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol. 1988 Jul;15(7):1109–1114. [PubMed]
  • Braun J, Sieper J. Inzeptionskohorte für Spondylarthropathien. Z Rheumatol. 2000 Apr;59(2):117–121. [PubMed]
  • Zink A, Braun J, Listing J, Wollenhaupt J. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol. 2000 Mar;27(3):613–622. [PubMed]
  • Feldtkeller E. Erkrankungsalter und Diagnoseverzögerung bei Spondylarthropathien. Z Rheumatol. 1999 Feb;58(1):21–30. [PubMed]
  • Brophy S, Calin A. Ankylosing spondylitis: interaction between genes, joints, age at onset, and disease expression. J Rheumatol. 2001 Oct;28(10):2283–2288. [PubMed]
  • Boonen A, Chorus A, Miedema H, van der Heijde D, Landewé R, Schouten H, van der Tempel H, van der Linden S. Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis. 2001 Nov;60(11):1033–1039. [PMC free article] [PubMed]
  • Dougados M, Gueguen A, Nakache JP, Velicitat P, Veys EM, Zeidler H, Calin A. Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology (Oxford) 1999 Mar;38(3):235–244. [PubMed]
  • Braunstein EM, Martel W, Moidel R. Ankylosing spondylitis in men and women: a clinical and radiographic comparison. Radiology. 1982 Jul;144(1):91–94. [PubMed]
  • Jiménez-Balderas FJ, Mintz G. Ankylosing spondylitis: clinical course in women and men. J Rheumatol. 1993 Dec;20(12):2069–2072. [PubMed]
  • Resnick D, Dwosh IL, Goergen TG, Shapiro RF, Utsinger PD, Wiesner KB, Bryan BL. Clinical and radiographic abnormalities in ankylosing spondylitis: a comparison of men and women. Radiology. 1976 May;119(2):293–297. [PubMed]
  • Kaipiainen-Seppanen O, Aho K, Heliovaara M. Incidence and prevalence of ankylosing spondylitis in Finland. J Rheumatol. 1997 Mar;24(3):496–499. [PubMed]
  • Gran JT, Husby G, Hordvik M. Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromsø, northern Norway. Ann Rheum Dis. 1985 Jun;44(6):359–367. [PMC free article] [PubMed]
  • Boyer GS, Templin DW, Cornoni-Huntley JC, Everett DF, Lawrence RC, Heyse SF, Miller MM, Goring WP. Prevalence of spondyloarthropathies in Alaskan Eskimos. J Rheumatol. 1994 Dec;21(12):2292–2297. [PubMed]
  • Hukuda S, Minami M, Saito T, Mitsui H, Matsui N, Komatsubara Y, Makino H, Shibata T, Shingu M, Sakou T, et al. Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society. J Rheumatol. 2001 Mar;28(3):554–559. [PubMed]
  • Brophy S, Pavy S, Lewis P, Taylor G, Bradbury L, Robertson D, Lovell C, Calin A. Inflammatory eye, skin, and bowel disease in spondyloarthritis: genetic, phenotypic, and environmental factors. J Rheumatol. 2001 Dec;28(12):2667–2673. [PubMed]
  • François RJ, Eulderink F, Bywaters EG. Commented glossary for rheumatic spinal diseases, based on pathology. Ann Rheum Dis. 1995 Aug;54(8):615–625. [PMC free article] [PubMed]
  • François RJ, Braun J, Khan MA. Entheses and enthesitis: a histopathologic review and relevance to spondyloarthritides. Curr Opin Rheumatol. 2001 Jul;13(4):255–264. [PubMed]
  • Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat. 2001 Nov;199(Pt 5):503–526. [PMC free article] [PubMed]
  • Maksymowych WP. Ankylosing spondylitis--at the interface of bone and cartilage. J Rheumatol. 2000 Oct;27(10):2295–2301. [PubMed]
  • Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis. 1971 May;30(3):213–223. [PMC free article] [PubMed]
  • François RJ, Gardner DL, Degrave EJ, Bywaters EG. Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis. Arthritis Rheum. 2000 Sep;43(9):2011–2024. [PubMed]
  • Laloux L, Voisin MC, Allain J, Martin N, Kerboull L, Chevalier X, Claudepierre P. Immunohistological study of entheses in spondyloarthropathies: comparison in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis. 2001 Apr;60(4):316–321. [PMC free article] [PubMed]
  • Bollow M, Fischer T, Reisshauer H, Backhaus M, Sieper J, Hamm B, Braun J. Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis- cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis. 2000 Feb;59(2):135–140. [PMC free article] [PubMed]
  • Sieper J, Braun J. Pathogenesis of spondylarthropathies. Persistent bacterial antigen, autoimmunity, or both? Arthritis Rheum. 1995 Nov;38(11):1547–1554. [PubMed]
  • Martínez-Borra J, González S, López-Larrea C. Genetic factors predisposing to spondylarthropathies. Arthritis Rheum. 2000 Mar;43(3):485–492. [PubMed]
  • Brown MA, Kennedy LG, MacGregor AJ, Darke C, Duncan E, Shatford JL, Taylor A, Calin A, Wordsworth P. Susceptibility to ankylosing spondylitis in twins: the role of genes, HLA, and the environment. Arthritis Rheum. 1997 Oct;40(10):1823–1828. [PubMed]
  • Reveille JD, Ball EJ, Khan MA. HLA-B27 and genetic predisposing factors in spondyloarthropathies. Curr Opin Rheumatol. 2001 Jul;13(4):265–272. [PubMed]
  • Breban M. Genetic studies of spondylarthropathies. French Spondylarthropathy Genetic Study Group. Ann Med Interne (Paris) 1998 Apr;149(3):142–144. [PubMed]
  • Laval SH, Timms A, Edwards S, Bradbury L, Brophy S, Milicic A, Rubin L, Siminovitch KA, Weeks DE, Calin A, et al. Whole-genome screening in ankylosing spondylitis: evidence of non-MHC genetic-susceptibility loci. Am J Hum Genet. 2001 Apr;68(4):918–926. [PMC free article] [PubMed]
  • Rudwaleit M, Höhler T. Cytokine gene polymorphisms relevant for the spondyloarthropathies. Curr Opin Rheumatol. 2001 Jul;13(4):250–254. [PubMed]
  • Sieper J, Braun J, Kingsley GH. Report on the Fourth International Workshop on Reactive Arthritis. Arthritis Rheum. 2000 Apr;43(4):720–734. [PubMed]
  • Gaston JS, Life PF, Granfors K, Merilahti-Palo R, Bailey L, Consalvey S, Toivanen A, Bacon PA. Synovial T lymphocyte recognition of organisms that trigger reactive arthritis. Clin Exp Immunol. 1989 Jun;76(3):348–353. [PMC free article] [PubMed]
  • Thiel A, Wu P, Lauster R, Braun J, Radbruch A, Sieper J. Analysis of the antigen-specific T cell response in reactive arthritis by flow cytometry. Arthritis Rheum. 2000 Dec;43(12):2834–2842. [PubMed]
  • Rudwaleit M, Siegert S, Yin Z, Eick J, Thiel A, Radbruch A, Sieper J, Braun J. Low T cell production of TNFalpha and IFNgamma in ankylosing spondylitis: its relation to HLA-B27 and influence of the TNF-308 gene polymorphism. Ann Rheum Dis. 2001 Jan;60(1):36–42. [PMC free article] [PubMed]
  • Simon AK, Seipelt E, Sieper J. Divergent T-cell cytokine patterns in inflammatory arthritis. Proc Natl Acad Sci U S A. 1994 Aug 30;91(18):8562–8566. [PMC free article] [PubMed]
  • Braun J, Yin Z, Spiller I, Siegert S, Rudwaleit M, Liu L, Radbruch A, Sieper J. Low secretion of tumor necrosis factor alpha, but no other Th1 or Th2 cytokines, by peripheral blood mononuclear cells correlates with chronicity in reactive arthritis. Arthritis Rheum. 1999 Oct;42(10):2039–2044. [PubMed]
  • Hoyle E, Laval SH, Calin A, Wordsworth BP, Brown MA. The X-chromosome and susceptibility to ankylosing spondylitis. Arthritis Rheum. 2000 Jun;43(6):1353–1355. [PubMed]
  • Mori K, Ushiyama T, Inoue K, Hukuda S. Polymorphic CAG repeats of the androgen receptor gene in Japanese male patients with ankylosing spondylitis. Rheumatology (Oxford) 2000 May;39(5):530–532. [PubMed]
  • Chou CT. Factors affecting the pathogenesis of ankylosing spondylitis. Chin Med J (Engl) 2001 Feb;114(2):211–212. [PubMed]
  • van der Linden SM, Valkenburg HA, de Jongh BM, Cats A. The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. Arthritis Rheum. 1984 Mar;27(3):241–249. [PubMed]
  • Burgos-Vargas R, Pacheco-Tena C, Vázquez-Mellado J. Juvenile-onset spondyloarthropathies. Rheum Dis Clin North Am. 1997 Aug;23(3):569–598. [PubMed]
  • Pacheco-Tena C, Alvarado De La Barrera C, López-Vidal Y, Vázquez-Mellado J, Richaud-Patin Y, Amieva RI, Llorente L, Martínez A, Zúiga J, Cifuentes-Alvarado M, et al. Bacterial DNA in synovial fluid cells of patients with juvenile onset spondyloarthropathies. Rheumatology (Oxford) 2001 Aug;40(8):920–927. [PubMed]
  • Underwood MR, Dawes P. Inflammatory back pain in primary care. Br J Rheumatol. 1995 Nov;34(11):1074–1077. [PubMed]
  • Mielants H, Veys EM, Joos R, Cuvelier C, De Vos M. Repeat ileocolonoscopy in reactive arthritis. J Rheumatol. 1987 Jun;14(3):456–458. [PubMed]
  • Mielants H, Veys EM, Cuvelier C, De Vos M. Course of gut inflammation in spondylarthropathies and therapeutic consequences. Baillieres Clin Rheumatol. 1996 Feb;10(1):147–164. [PubMed]
  • Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H, van der Tempel H, van der Linden S. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):980–984. [PubMed]
  • Braun J, Brandt J, Listing J, Zink A, Alten R, Golder W, Gromnica-Ihle E, Kellner H, Krause A, Schneider M, et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet. 2002 Apr 6;359(9313):1187–1193. [PubMed]
  • Dougados M, Gueguen A, Nakache JP, Velicitat P, Zeidler H, Veys E, Calin A. Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):971–974. [PubMed]
  • Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol. 1999 Apr;26(4):966–970. [PubMed]
  • Taylor HG, Wardle T, Beswick EJ, Dawes PT. The relationship of clinical and laboratory measurements to radiological change in ankylosing spondylitis. Br J Rheumatol. 1991 Oct;30(5):330–335. [PubMed]
  • Oostveen J, Prevo R, den Boer J, van de Laar M. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol. 1999 Sep;26(9):1953–1958. [PubMed]
  • Braun J, Bollow M, Eggens U, König H, Distler A, Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum. 1994 Jul;37(7):1039–1045. [PubMed]
  • Blum U, Buitrago-Tellez C, Mundinger A, Krause T, Laubenberger J, Vaith P, Peter HH, Langer M. Magnetic resonance imaging (MRI) for detection of active sacroiliitis--a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol. 1996 Dec;23(12):2107–2115. [PubMed]
  • Calin A, Porta J, Fries JF, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA. 1977 Jun 13;237(24):2613–2614. [PubMed]
  • van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. [PubMed]
  • Khan MA, Khan MK. Diagnostic value of HLA-B27 testing ankylosing spondylitis and Reiter's syndrome. Ann Intern Med. 1982 Jan;96(1):70–76. [PubMed]
  • Carette S, Graham D, Little H, Rubenstein J, Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum. 1983 Feb;26(2):186–190. [PubMed]
  • Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994 Oct;21(10):1883–1887. [PubMed]
  • McBryde AM, Jr, McCollum DE. Ankylosing spondylitis in women. The disease and its prognosis. N C Med J. 1973 Jan;34(1):34–37. [PubMed]
  • HART FD, ROBINSON KC. Ankylosing spondylitis in women. Ann Rheum Dis. 1959 Mar;18(1):15–23. [PMC free article] [PubMed]
  • Burgos-Vargas R, Naranjo A, Castillo J, Katona G. Ankylosing spondylitis in the Mexican mestizo: patterns of disease according to age at onset. J Rheumatol. 1989 Feb;16(2):186–191. [PubMed]
  • Boonen A, de Vet H, van der Heijde D, van der Linden S. Work status and its determinants among patients with ankylosing spondylitis. A systematic literature review. J Rheumatol. 2001 May;28(5):1056–1062. [PubMed]
  • Ward MM, Kuzis S. Risk factors for work disability in patients with ankylosing spondylitis. J Rheumatol. 2001 Feb;28(2):315–321. [PubMed]
  • Barlow JH, Wright CC, Williams B, Keat A. Work disability among people with ankylosing spondylitis. Arthritis Rheum. 2001 Oct;45(5):424–429. [PubMed]
  • Boonen A, van der Heijde D, Landewé R, Spoorenberg A, Schouten H, Rutten-van Mölken M, Guillemin F, Dougados M, Mielants H, de Vlam K, et al. Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis. 2002 May;61(5):429–437. [PMC free article] [PubMed]
  • Boonen A, Chorus A, Miedema H, van der Heijde D, van der Tempel H, van der Linden S. Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis. 2001 Apr;60(4):353–358. [PMC free article] [PubMed]
  • Ward Michael M. Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum. 2002 Jan;46(1):223–231. [PubMed]
  • Cooper NJ. Economic burden of rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 2000 Jan;39(1):28–33. [PubMed]
  • Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res. 1999 Aug;12(4):247–255. [PubMed]

Figures and Tables

Figure 1
Evolution from undifferentiated spondyloarthropathy (uSpA) to ankylosing spondylitis (AS) in patients with definitive radiological sacroiliitis.69 This previously unpublished figure is based on data published by Dr W Mau and is printed with the author's ...
Figure 2
A biopsy specimen from a patient with acute sacroiliitis shows cellular infiltrate containing activated fibroblasts and lymphocytes that seem to invade a degenerate cartilaginous area.94 Reproduced with permission of the author and the copyright holders ...
Figure 3
Pelvic radiograph of a patient with AS showing sacroiliitis grade II on the right side and grade II–III on the left. This previously unpublished figure is provided courtesy of Dr M Rudwaleit.
Figure 4
Pelvic radiograph of a patient with AS showing bilateral sacroiliitis grade III. This previously unpublished figure is provided courtesy of Dr M Rudwaleit.
Figure 5
Pelvic radiograph (A) showing suspicious changes: a small circumscribed zone of sclerosis of the left sacroiliac joint (sacroiliitis grade I–II) and slightly blurred joint margins of the right sacroiliac joint (grade I). The corresponding MRI ...
Figure 6
Diagnostic algorithm for axial SpA (early AS) starting with the assessment of inflammatory back pain. The combination of several typical SpA manifestations results in a high disease probability. This figure will be published in Ankylosing spondylitis: ...

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...