Which condition presents with inflammatory back pain that improves with exercise?

• A. Ankylosing spondylitis
• B. Osteoarthritis
• C. Rheumatoid arthritis
• D. Gout

Answer: (A)

Inflammatory back pain is defined by morning stiffness that lasts longer, often starting before age 40, and improves with activity or exercise rather than worsens with movement. Ankylosing spondylitis is the classic example of this pattern in the spine, presenting with chronic inflammatory back pain and stiffness that improves with exercise and activity. The spine and sacroiliac joints are affected, and over time mobility can be limited due to inflammation and fusion.

Osteoarthritis tends to be a mechanical, degenerative process where pain worsens with use and activity and often improves with rest, not the typical inflammatory pattern. Rheumatoid arthritis can involve the spine but usually presents with peripheral joint synovitis and is not characterized primarily by inflammatory back pain of the axial skeleton. Gout mainly affects peripheral joints with acute inflammatory flares and is not a common cause of inflammatory back pain.

So the best fit for inflammatory back pain that improves with exercise is ankylosing spondylitis.