Delayed diagnosis is common because symptoms are often attributed to more common back problems. A dramatic loss of flexibility in the lumbar spine is an early sign of AS. Although most symptoms begin in the lumbar and sacroiliac areas, they may involve the neck and upper back as well. Arthritis may also occur in the shoulder, hips and feet. Some patients have eye inflammation, and more severe cases must be observed for heart valve involvement.
At times, AS may presage the development of inflammatory bowel disease, and some patients have fever, fatigue, weight loss, anemia, eye inflammation (called iritis), and more severe cases may involve heart valve dysfunction. Other disorders of the internal organs and bones mimic spondylarthropathies and must be distinguished. Laboratory evaluation may reveal an elevated sedimentation rate (an indicator of inflammation), anemia and a positive HLA-B27 assay. X-rays and bone scans may show characteristic changes.
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