American Board of Family Medicine (ABFM) Practice Exam

What other symptom, aside from stiffness, often accompanies ankylosing spondylitis?

1. Fatigue

2. Chest pain

3. Pain worse in the evening

4. Weight gain

The correct answer is: Pain worse in the evening

Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. The hallmark of this condition is typically a characteristic stiffness, particularly in the lower back, which tends to improve with movement and worsen with periods of inactivity, such as at night or in the morning. In addition to stiffness, pain often becomes more pronounced in the evening and nighttime. This pattern may stem from changes in posture during sleep or from the body's natural circadian rhythms that can increase the perception of pain. As patients in the early stages of ankylosing spondylitis experience night pain, they frequently report waking up in the night, sometimes requiring them to change positions or get out of bed to find relief. Fatigue is a common symptom in many inflammatory conditions, including ankylosing spondylitis, as the body is engaged in ongoing immune responses. However, it is not as specific to this condition as the pattern of pain worsening in the evening. Chest pain can occur in advanced cases due to involvement of the thoracic spine or rib cage, but it is not a typical symptom in early stages. Weight gain is not commonly associated with ankylosing spondylitis; in fact