Ankylosing Spondylitis: Diagnosis and Treatment Options - Internal Medicine

More Info

---

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is classified under a group of diseases known as spondyloarthritis. The diagnosis of AS can be complex, especially when considering factors such as negative genetic markers (like HLA-B27), normal inflammatory markers, and the presence of symptoms.

1. Diagnosis of Ankylosing Spondylitis:
The diagnosis of AS is typically made based on clinical symptoms, imaging studies, and laboratory tests. While the presence of HLA-B27 is a common genetic marker associated with AS, it is not definitive. Many individuals with AS may test negative for this marker. Additionally, the inflammatory markers in the blood can be normal in some patients, especially in the early stages of the disease. The X-ray findings you mentioned, which indicate changes consistent with AS, can be significant. However, it is essential to correlate these findings with your symptoms and clinical examination. Misdiagnosis can occur, particularly if the imaging findings are subtle or if the clinical presentation does not align with typical AS symptoms.

2. Medication and Treatment:
The medications you mentioned, such as Ketorolac (克他服寧) and Meloxicam (萬克適), are non-steroidal anti-inflammatory drugs (NSAIDs) used to manage pain and inflammation. While these medications can provide symptomatic relief, they do not modify the disease course. NSAIDs are often the first line of treatment for AS, and their effectiveness can vary from person to person. If you find that Meloxicam provides some relief, it indicates that inflammation is likely contributing to your symptoms. However, if you stop taking it, the pain may return, as these medications do not address the underlying disease process.

3. Further Evaluation:
Given your symptoms and the complexity of your case, it may be beneficial to seek further evaluation from a rheumatologist who specializes in spondyloarthritis. They may consider additional imaging modalities, such as MRI, which can detect early inflammatory changes in the sacroiliac joints that X-rays might miss. Moreover, they may explore other treatment options, including disease-modifying antirheumatic drugs (DMARDs) or biologics, which can provide more effective long-term management for AS.

4. Lifestyle and Physical Therapy:
In addition to medication, physical therapy and regular exercise are crucial components of managing AS. Engaging in a structured exercise program can help maintain flexibility and reduce stiffness. Activities such as swimming, yoga, and stretching can be particularly beneficial.
5. Monitoring and Follow-Up:
Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as necessary. Keeping a symptom diary can also help track the effectiveness of medications and identify any triggers for your pain.

In summary, while your current symptoms and imaging suggest AS, the negative genetic test and normal inflammatory markers complicate the diagnosis. It is crucial to work closely with a rheumatologist to ensure an accurate diagnosis and appropriate treatment plan tailored to your needs.