Ankylosing Spondylitis, Rheumatologic Perspective (cont.)
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Exams and Tests
The diagnosis of ankylosing spondylitis is made by combining clinical information with findings of a variety of tests. The diagnosis is suggested by typical symptoms of ankylosing spondylitis described above, and supported by a family history of ankylosing spondylitis, x-ray film findings, and a positive test for the gene for HLA-B27. People with active ankylosing spondylitis can have elevated blood tests that measure inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein. Blood counts can indicate anemia (low red blood count). If symptoms are present, and the gene marker for HLA-B27 is detected on blood testing, ankylosing spondylitis is considered. Of note, the absence of the gene marker for HLA-B27 means that ankylosing spondylitis is less likely to be present. However, blood relatives of people with ankylosing spondylitis could have the condition without having the HLAB27 marker.
X-ray examination of the spine of people with ankylosing spondylitis can reveal characteristic bony changes in the sacroiliac joints and the spine. MRI or CT scan can be used to detect early signs of inflammation in the sacroiliac joints and the spine that may not be visible with simple x-ray tests. However, because of their high cost, MRI and CT scans are not part of the routine examinations of people with suspected ankylosing spondylitis.
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The spondyloarthropathies (SpAs) are a family of related disorders that includes ankylosing spondylitis (AS), reactive arthritis (ReA; also known as Reiter syndrome [RS]), psoriatic arthritis (PsA), spondyloarthropathy associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthropathy (USpA), and, possibly, Whipple disease and Behçet disease.