A diagnosis of spondyloarthritis is often delayed because chronic back pain is frequently misidentified as mechanical in origin. Early recognition of inflammatory back pain and its extra-articular manifestations is crucial for preventing irreversible structural damage. In this report, the case of a 25-year-old male with a one-year history of insidious back pain and alternating buttock pain is presented. Despite normal Schober test results and ambiguous initial radiographs, the patient had classic features of spondyloarthritis, including peripheral arthritis, acute anterior uveitis, a positive family history, and HLA-B27 positivity. Although the 1984 modified New York criteria require radiographic evidence of sacroiliitis, modern diagnostic roadmaps use the 2009 Assessment of SpondyloArthritis International Society criteria. In this case, magnetic resonance imaging revealed significant subchondral bone marrow edema in the sacroiliac joints, confirming a diagnosis of axial spondyloarthritis. By integrating clinical features, laboratory markers, and advanced imaging findings, clinicians can navigate the diagnostic roadmap to ensure timely intervention and improve the long-term prognosis of young patients presenting with chronic back pain.
Hyemin Jeong (Mon,) studied this question.
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