Diagnosis of Ankylosing Spondylitis: Do not let the spine bites the eye.

BACKGROUND: A diagnosis of ankylosing spondylitis (AS) is challenging and often delayed despite patients being symptomatic. Low back pain is the most common initial symptom, appearing in the second and third decades of life. Acute anterior uveitis (AAU) occurs much later in the course of the disease, often when the destruction of the spine is already debilitating.
OBJECTIVE: Here, we report three cases of AS that were diagnosed after the patients developed AAU.
Methods: A case series illustrated AAU leading to the diagnosis of AS years after the initial episode of low back pain. A comparison of the clinical presentation, diagnosis, and outcomes was also illustrated. RESULT: We report three cases of acute anterior uveitis (AAU)-associated AS diagnosed only after many visits to the primary health care provider with the complaint of chronic low back pain. All three patients had irreversible radiological changes upon diagnosis of AS. The AAU resolved with topical steroids, and one patient developed cataract.
CONCLUSION: A high index of suspicion of AS in a young adult with chronic back pain before the development of AAU may prevent further functional loss and provide a better prognosis. Diagnosis of AS following AAU is not only associated with dependency but also may rob the vision of a young adult. © Academy of Family Physicians of Malaysia.