Ankylosing spondylitis x ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
X ray
- indistinct joints
- joints widen before narrow
- subchondral erosions, sclerosis, and proliferation on iliac side of SI joints
- at endstage, sacroiliac joint may be a thin line or not visible
- in the spine, early spondylitis is characterized by small erosions at the corners of vertebral bodies with reactive sclerosis
- squaring of the vertebral body
- syndesmophyte formation, with bridging of the corners of one vertebra to another
- ossification of paravertebral connective tissue fibers, including posterior interspinous ligaments as well as linking of spinous processes leads to an appearance of a solid midline vertical dense line on AP projection
- may see associated pseudoarthroses (discovertebral destruction with adjacent sclerosis) and enthesopathic changes (ill-defined erosions with adjacent sclerosis at sites of ligamentous and tendenous attachments)
- hip involvement is generally bilateral and symmetric, with uniform joint space narrowing, axial migration of the femoral head, and a collar of osteophytes at the femoral head-neck junction
- knees demonstrate uniform joint space narrowing with bony proliferation
- hands are generally involved asymmetrically, with smaller, shallower erosions and marginal periostitis.
- radiographs of the lungs may demonstrate progressive fibrosis and bullous changes at the apices. These lesions may resemble TB infection and bullae may become infected.