Ankylosing spondylitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ankylosing spondylitis needs to be differentiated from certain conditions such as a strain of the psoriatic arthritis,rheumatoid arthritis and reactive arthritis.

Differentiating Ankylosing spondylitis from other Diseases

• Ankylosing spondylitis must be differentiated from other diseases causing oligo/polyarthritis or arthritis of the axial skeleton, including: {| 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 |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==

Differential diagnosis of psoriatic arthritis

Psoriatic arthritis must be differentiated from other diseases causing oligo/polyarthritis or arthritis of the axial skeleton, including:

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