Early Cases of Spondylarthritis Anchylopoetica

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Advanced spondylarthritis presents no diagnostic difficulties. Reports in the literature generally describe the final stage, with the kyphotic, stiff back and typical roentgen changes, calcification of the ligaments and ankylosis of the intervertebral joints. During the last 20 years however, a study of the early stages has commenced. The works of Krebs (14, 15, 16) and Scott (18, 19), at the beginning of the 1930's. showed that the disease practically always manifests itself symmetrically at the onset, with arthritis in the sacro-iliac joints, but, strangely enough, without the appearance of any local symptoms in this region. The early symptoms are diffuse. They usually appear in the form of attacks of pain, of myalgic or radicular type: the pain may move from one region to another with pain-free intervals. It can happen that misjudgement of cases may continue for several years while such diagnoses are given as rheumatism, myalgia, growing pains and fibrositis etc. In all their irregularity, however, the symptoms are yet in some way characteristic. Scott even bases the diagnosis solely on the anamnesis, though roentgen changes may be absent in the sacroiliac joints. He calls the symptoms prespondylitic and has encountered them in 95 % of 300 cases. He goes so far as to say that spinal symptoms first appear when arthritis of the sacro-iliac joints has reached the stage of ankylosis. The disease is often overlooked owing to the remarkable circumstance that, as mentioned before, no local symptoms proceed from these joints. A reliable diagnosis can only be made through radiographic examination of the sacro-iliac joints, Lecture given at a meeting of the Nordisk Reumatologisk Fijrening in Oslo,