← all past rounds

iatroX Rounds #19

Sunday, 12 July 2026·Rheumatologymoderate

The clues

  1. 1

    A 28-year-old man presents with a six-month history of lower back pain and stiffness.

  2. 2

    The discomfort is most severe in the morning and lasts for over an hour, but it improves significantly with physical activity.

  3. 3

    He reports that the pain often wakes him during the second half of the night, forcing him to get out of bed and walk around.

  4. 4

    Clinical assessment shows reduced lumbar flexion during forward bending and tenderness upon palpation of the sacroiliac joints.

  5. 5

    Inflammatory markers are mildly raised, and he is found to carry the HLA-B27 antigen.

  6. 6

    Radiographs of the pelvis show bilateral sacroiliitis, and spinal imaging reveals vertical bony growths between the vertebrae.

the diagnosis
Ankylosing spondylitis

<p><strong>Ankylosing spondylitis</strong> is a chronic inflammatory arthritis of the axial skeleton, typically affecting young adults. It is part of the spondyloarthritis spectrum and is strongly associated with the <strong>HLA-B27</strong> gene.</p>

  • <strong>Inflammatory back pain</strong> that improves with exercise
  • Morning stiffness lasting more than 30 minutes
  • Reduced spinal mobility in all planes
  • Association with extra-articular features like <strong>anterior uveitis</strong>
pearl. <p>The hallmark of this condition is <strong>inflammatory back pain</strong>, which is uniquely characterised by <strong>improvement with exercise</strong> and a lack of relief with rest.</p>

more Rheumatology rounds

A 48-year-old woman presents with worsening shortness of breath on exertion and a dry cough over the last six months.#31A 72-year-old man presents with deep, boring pain in his right hip and thigh that has been gradually worsening over the last six months.#28A 54 year old man presents with a persistent runny nose, crusting, and intermittent nosebleeds that have lasted for four months.#22A 28-year-old woman of Afro-Caribbean heritage presents with fatigue and joint pains that have been worsening over several months.#15

keep learning

practise free questionsexplore the academyall past rounds
play today’s round

for education and entertainment. not medical advice.