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A 37-year-old female patient presented with localized, continuous, stabbing back and hip pain which had been occurring for 15 years. She had been diagnosed with FMF, and colchicine had been prescribed which decreased the frequency and severity of the attacks. In the following years, she was prescribed indomethacin and sulfasalazine with the diagnosis of AS. Sacroiliac compression tests were negative, but Patrick’s test was positive on the left side. Chest expansion and Schober’s lumbar measurements were 2.5 and 4 cm, respectively. Low back flexion and extension ranges were normal but painful at the extremes. Chin-sternum and occiput-wall distances were normal. Peripheral arthritis was absent. Straight leg raising and femoral stretch tests were negative, and biochemical tests, complete blood count (CBC), and urinalysis were normal. The erythrocyte sedimentation rate (ESR) was 14 mm/h, and C reactive protein (CRP) was 0.48 mg/dl (0.01-0.82). The rheumatoid factor (RF) and human leukocyte antigen (HLA)-B27 were negative. Magnetic resonance imaging (MRI) disclosed sclerosis, contrast enhancement, and narrowing of the sacroiliac joints compatible with bilateral sacroiliitis. However, lumbar X-rays revealed minimal changes, indicating spondyloarthropathy in the spine.

Differentiation Between Familial Mediterranean Fever Related Spondyloarthropathy and Ankylosing Spondylitis