Ankylosing spondylitis differential diagnosis: Difference between revisions

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__NOTOC__
{{CMG}} ; {{AE}} {{VKG}}
{{Ankylosing spondylitis}}
{{CMG}}


==Overview==
== Overview ==
Ankylosing spondylitis needs to be differentiated from certain conditions such as a strain of the psoriatic arthritis,rheumatoid arthritis and reactive arthritis.
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Ankylosing_spondylitis]]
[[Ankylosing spondylitis]] must be differentiated from other diseases causing [[reactive arthritis]],[[rheumatoid arthritis]] and [[psoriatic arthritis]].


==Differentiating Ankylosing spondylitis from other Diseases==
== Preferred Table ==
* Ankylosing spondylitis must be differentiated from other diseases causing [[Oligoarthritis|oligo]]/[[polyarthritis]] or [[arthritis]] of the [[axial skeleton]], including:<small> {| class="wikitable" ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type ! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features ! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution ! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs ! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities |- | |'''History of Psoriasis''' |'''Symmetric [[joint]] involvement''' |'''Asymmetric [[joint]] involvement''' |[[Enthesopathy|'''Enthesopathy''']] |'''[[Dactylitis]]''' |'''[[Nail (anatomy)|Nail]] [[Dystrophy]]''' |'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association''' |'''[[Upper extremity]]-hands''' |'''[[Lower extremity]]''' |'''[[Sacroiliac joint|Sacroiliac joints]]''' |'''[[Spine]]''' |'''[[Osteopenia]]''' |'''[[Joint]] Space''' |'''[[Ankylosis]]''' |'''[[Periostitis]]''' |'''[[Soft tissue]] swelling''' |'''[[ESR]]''' |'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])''' |'''[[HLA-B27]]''' |- |'''[[Psoriatic arthritis]]''' | + | + | ++ | + | + | + | + | +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]]) | +++ | ++ (Unilateral) | ++ | - | ++ (Widening) | ++ | +++ (Fluffy) | ++ | + | - |30-75% |- |'''[[Rheumatoid arthritis]]''' | - | ++ | + | - | - | - | - | +++  ([[MCP joints|MCP]]/[[wrist]]) | +++ | + (Unilateral) | ++([[Cervical spine|Cervical]]) | +++ | +++ (Narrowing) | + | + (Linear) | +++ | +++ | +++ |6-8% |- |'''[[Ankylosing spondylitis]]''' | - | +++ | - | + | - | - | - | + | + | +++ (Bilateral) | +++ | +++ | ++ (Narrowing) | +++ | +++ (Fluffy) | + | +++ | - |90% |- |'''[[Reactive arthritis]] ([[Reiter's syndrome]])''' | - | +++ | - | + | + | - | - | ++ | +++ | ++ (Unilateral) | + | + | + (Narrowing) | - | +++ (Fluffy) | ++ | ++ | - |75% |}  Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent  ==References==


===Differential diagnosis of psoriatic arthritis===
{| class="wikitable"
Psoriatic arthritis must be differentiated from other diseases causing [[Oligoarthritis|oligo]]/[[polyarthritis]] or [[arthritis]] of the [[axial skeleton]], including:
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|-
|
|
|'''History of Psoriasis'''
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|[[Enthesopathy|'''Enthesopathy''']]
|[[Enthesopathy|'''Enthesopathy''']]
|'''[[Dactylitis]]'''
|'''[[Dactylitis]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Upper extremity]]-hands'''
|'''[[Upper extremity]]-hands'''
|'''[[Lower extremity]]'''
|'''[[Lower extremity]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Spine]]'''
|'''[[Osteopenia]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Ankylosis]]'''
|'''[[Periostitis]]'''
|'''[[Periostitis]]'''
|'''[[Soft tissue]] swelling'''
|'''[[Soft tissue]] swelling'''
|'''[[ESR]]'''
|'''[[ESR]]'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|'''[[HLA-B27]]'''
|-
|-
|'''[[Psoriatic arthritis]]'''
|'''[[Psoriatic arthritis]]'''
| +
| +
| +
| +
| ++
| ++
| +
| +
| +
| +
| +
| +
| +
| +
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++
| +++
| ++ (Unilateral)
| ++ (Unilateral)
| ++
| ++
| -
| -
| ++ (Widening)
| ++ (Widening)
| ++
| ++
| +++ (Fluffy)
| +++ (Fluffy)
| ++
| ++
| +
| +
| -
| -
|30-75%
|30-75%
|-
|-
|'''[[Rheumatoid arthritis]]'''
|'''[[Rheumatoid arthritis]]'''
| -
| -
| ++
| ++
| +
| +
| -
| -
| -
| -
| -
| -
| -
| -
 
| +++
| +++  
([[MCP joints|MCP]]/[[wrist]])
([[MCP joints|MCP]]/[[wrist]])
| +++
| +++
| + (Unilateral)
| + (Unilateral)
| ++([[Cervical spine|Cervical]])
| ++([[Cervical spine|Cervical]])
| +++
| +++
| +++ (Narrowing)
| +++ (Narrowing)
| +
| +
| + (Linear)
| + (Linear)
| +++
| +++
| +++
| +++
| +++
| +++
|6-8%
|6-8%
|-
|-
|'''[[Ankylosing spondylitis]]'''
|'''[[Ankylosing spondylitis]]'''
| -
| -
| +++
| +++
| -
| -
| +
| +
| -
| -
| -
| -
| -
| -
| +
| +
| +
| +
| +++ (Bilateral)
| +++ (Bilateral)
| +++
| +++
| +++
| +++
| ++ (Narrowing)
| ++ (Narrowing)
| +++
| +++
| +++ (Fluffy)
| +++ (Fluffy)
| +
| +
| +++
| +++
| -
| -
|90%
|90%
|-
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| -
| -
| +++
| +++
| -
| -
| +
| +
| +
| +
| -
| -
| -
| -
| ++
| ++
| +++
| +++
| ++ (Unilateral)
| ++ (Unilateral)
| +
| +
| +
| +
| + (Narrowing)
| + (Narrowing)
| -
| -
| +++ (Fluffy)
| +++ (Fluffy)
| ++
| ++
| ++
| ++
| -
| -
|75%
|75%
 
|}
|} Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
 
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Arthritis]]
[[Category:Autoimmune diseases]]

Latest revision as of 20:12, 20 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Ankylosing spondylitis must be differentiated from other diseases causing reactive arthritis,rheumatoid arthritis and psoriatic arthritis.

Preferred Table

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%
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