Ankylosing spondylitis differential diagnosis

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

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

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%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

References