Challenges in Diagnosing Radiographic Axial Spondyloarthritis: A Case Study of a Young Adult in a Secondary-Level General Hospital in Guayaquil, Ecuador

Radiographic axial spondyloarthritis is a chronic autoimmune disorder primarily affecting the axial skeleton, causing pain, stiffness, and, in advanced cases, structural damage. Its varied clinical presentation complicates diagnosis, particularly in resource-limited settings like secondary-level hospitals in Ecuador. This report details the case of a 34-year-old female initially misdiagnosed with seronegative rheumatoid arthritis and treated with methotrexate, hydroxychloroquine, and corticosteroids. Despite treatment, her symptoms persisted until an MRI, limited by unavailable STIR sequences, confirmed left-sided sacroiliitis. The case was further complicated by idiopathic sudden hearing loss, severe hip involvement, and osteopenia. Cultures were negative, and the diagnosis was ultimately based on clinical criteria and imaging findings. This case highlights the challenges of diagnosing radiographic axial spondyloarthritis in resource-limited settings, and underscores the importance of interdisciplinary evaluation to avoid diagnostic delays and long-term disability.