Can Ankylosing Spondylitis present with peripheral involvement?

• A. No, AS is strictly axial
• B. Only peripheral
• C. Yes, can be axial or peripheral
• D. Only axial

Answer: (C)

Ankylosing Spondylitis is classically known for spine and sacroiliac joint inflammation, but it is part of a broader group of spondyloarthropathies that can involve peripheral joints and entheses as well. This means the disease can present with axial symptoms, peripheral symptoms, or both. Peripheral involvement often appears as peripheral arthritis of the hips, knees, or shoulders, and enthesitis at sites like the Achilles tendon or plantar fascia; these peripheral features can be asymmetric and may occur at any stage of the disease.

So the best answer recognizes that inflammation in AS is not limited to the spine—it can be axial or peripheral. The other options imply exclusivity to one region, which is inconsistent with how AS can manifest in real patients.