Keywords: Ankylosing Spondilitis, clinical case, diagnostic suspicion, learning opportunity
Ankylosing Spondilitis (AS) is a seronegative spondyloarthropathy, also known as Marie-Strümpell or Bechterew’s disease. Presented with atypical symptoms in the 3rd decade of life, AS often is misdiagnosed as low-back pain syndrome and remains untreated for years. Appropriate training of Primary Care (PC) Physicians is crucial for early diagnosis and proper management of AS patients in PC settings.
To share our teaching experience utilizing an AS clinical case as a learning opportunity for GP/FM Residents in PC settings.
Narrative description of a teaching experience based on an AS clinical case presentation.
A case of 78-year-old male, reporting persistent gluteal pain and low-back stiffness for the past 20 years, seriously affecting his everyday life and functionality. According to the patient, no clinically significant pathologic findings were detected to explain his symptoms. Pain-relief medication has been sporadically recommended. The patient was referred to PC Radiologist. Plain X-rays were performed, revealing specific AS signs. The case was later presented to GP/FM Residents as a small-group training project aiming to deliver a diagnostic hypothesis and management plan for the patient. Chronic low-back pain due to long-term physical strain and orthopedic specialist referral were presented as most probable scenario.
The atypical AS clinical presentation usually causes major delay of correct diagnosis and appropriate therapeutic management and substantial burden on patient’s health status and quality of life. Utilizing this clinical case, a major challenge of clinical practice was transformed into a valuable learning opportunity focused on the role of clinical diagnostic suspicion and basic clinical skills. Another very encouraging outcome of this teaching experience was the collaboration established with PC Radiologist as a member of the GP/FM teaching team.
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