A. The classic presentation occurs in a young man between 15 and 40 years old who experiences the insidious onset of intermittent or persistent low back pain and stiffness that is often worse in the morning hours and after prolonged rest. The pain is typically relieved by physical activity. It is usually centered in the lumbosacral spine but may also be present in the buttocks and hips and occasionally radiate into the thighs.
C. Peripheral arthritis occurs in one-half of patients during the course of AS. Involved joints are usually large and proximal, such as the hips and shoulders.
1. Hip involvement is a major source of disability in AS.
2. Heel pain may occur secondary to local enthesopathy of the calcaneus; Achilles tendinitis is also common.
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