Do All Ankylosing Spondylitis Patients Experience Morning Stiffness? - Internal Medicine

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Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, which can lead to pain and stiffness. One of the hallmark symptoms of AS is morning stiffness, but it is important to note that not all patients experience this symptom.
1) Do all Ankylosing Spondylitis patients experience morning stiffness?
Morning stiffness is indeed a common symptom among AS patients, but it is not universal. Some individuals may experience stiffness that improves with movement, while others may not have significant morning stiffness at all. The absence of morning stiffness does not rule out the diagnosis of AS. Each patient's experience can vary widely, and symptoms can manifest differently based on individual factors, including the severity of the disease, the presence of other conditions, and personal pain thresholds.
In your case, despite being diagnosed with AS and having imaging evidence of sacroiliitis, you report no morning stiffness. This could suggest that your particular manifestation of AS is atypical, or that other factors may be influencing your symptoms. It is crucial to communicate these observations with your rheumatologist, as they can provide insights into your specific situation and adjust your treatment plan accordingly.

2) Does pain in the sacroiliac joints in AS patients always improve with activity?
While many AS patients find that their pain improves with movement, this is not a definitive rule. Some individuals may experience persistent pain in the sacroiliac joints regardless of activity. The pain can be influenced by various factors, including the level of inflammation, the presence of other musculoskeletal issues, and individual variations in pain perception. Your experience of pain that does not alleviate with activity is significant and should be discussed with your healthcare provider.
3) Am I definitely suffering from Ankylosing Spondylitis?
Based on the information you provided, including your HLA-B27 positivity, MRI findings of bilateral sacroiliitis, and elevated inflammatory markers (CRP and ESR), it is reasonable to conclude that you have AS. However, the diagnosis of AS is not solely based on imaging or laboratory findings; it also considers clinical symptoms and the overall pattern of disease. Since you have not experienced morning stiffness and your pain does not improve with activity, it is essential to have an open dialogue with your rheumatologist. They may consider further evaluations or alternative diagnoses if your symptoms do not align with typical AS presentations.

In conclusion, while morning stiffness and pain relief with activity are common features of AS, they are not absolute indicators of the disease. Your unique symptom profile is important for your healthcare provider to understand in order to tailor your treatment effectively. Regular follow-ups and open communication with your rheumatologist will be key in managing your condition and addressing any concerns you may have.