Dorso-Lumbar Pain in a Woman Diagnosed With Ankylosing Spondylitis

A 41-year-old woman with a history of smoking 5 cigarettes a day was diagnosed at 27 years of age with ankylosing spondylitis with a positive HLA-B27, according to the modified New York criteria. She was initially treated with analgesics and sulphasalazine, receiving up to 1000 mg/day, not tolerating a higher dose due to gastrointestinal complications, achieving good control of her disease. In March 2004, the patient presented intense dorsolumbar pain that increased with rest and improved with movement. The pain partially improved with the use of paracetamol and muscle relaxants. She did not present fever nor constitutional symptoms and had no history of trauma. The physical examination evidenced pain of the spinous processes of the dorsolumbar spine, a modified Schober test of 1.3 cm, a finger-floor distance of 5 cm, BASFI (Bath Ankylosing Spondylitis Functional Index) of 51, and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) of 48. The laboratory testing showed: hemoglobin, 11.6 g/dL (12-15); mean corpuscular volume, 83.20 fl (78-100); erythrocyte sedimentation rate, 25 (020); and CRP, 5.4 mg/L (0-5). The blood chemistry, blood proteins, and urine tests were normal. PPD was positive (11 mm), with a normal chest x-ray. Blood cultures, serology for Brucella and acid-alcohol resistant bacilli in urine were negative. The patient had a lumbar spine x-ray that showed a wedgelike appearance of D-12 which had not been observed on previous x-rays as well as osteopenia and squaring of the vertebral bodies. The study was completed with a STIR magnetic resonance (MR) of the spine (Figure 1) which showed a hyperintense image in T2 with fat suppression, compatible with a grade C1 Anderson lesion (edema of the vertebral body) at the level of D7 and D8; a Dorso-Lumbar Pain in a Woman Diagnosed With Ankylosing Spondylitis