Inflammation Index and Its Impact on Adhesion in Ankylosing Spondylitis

The relationship between inflammatory indices and adhesions?

Hello, Doctor.
I have ankylosing spondylitis.
Before treatment, I experienced pain in my buttocks and lower back.
For the past year, I have been taking two tablets of Celebrex daily, and my CRP levels have been maintained within the normal range.
The pain in my buttocks has almost disappeared, but I still feel slight pain in my lower back when I lean back (though I don't notice it during exercise or daily activities unless I specifically lean back a lot).
I have tried taking Voltaren and Humira, but they were ineffective.
I would like to ask the doctor: 1) Since my levels are now normal and my buttock pain is almost gone, can I ignore the slight lower back pain that only occurs when I lean back a lot, as it does not affect my daily life? 2) I think that since my levels are normal, the chance of adhesions in my lower back is very low.
Is my thinking correct? Thank you, Doctor.

Hao, 20~29 year old female. Ask Date: 2023/04/01

Dr. Zeng Guosen reply Internal Medicine

The likelihood of spinal adhesions is related to various factors, including inflammation levels, smoking, previous adhesions, obesity, and more.
Of course, if there is no pain and inflammation levels are normal, the chances of developing adhesions in the lower back are reduced.
Experiencing back pain primarily when leaning backward is typically not a common symptom of ankylosing spondylitis; a follow-up evaluation is recommended.

Reply Date: 2023/04/01

More Info

Understanding the relationship between inflammation indices and conditions like Ankylosing Spondylitis (AS) is crucial for managing this chronic inflammatory disease. Ankylosing Spondylitis primarily affects the spine and the sacroiliac joints, leading to pain and stiffness. The inflammation can also affect other areas, including the hips and peripheral joints.
In your case, it’s encouraging to hear that your CRP (C-reactive protein) levels are within the normal range and that you are experiencing significant relief from pain in your buttocks. CRP is a marker of inflammation in the body, and its levels can indicate the presence of inflammation associated with conditions like AS. When CRP levels are normal, it generally suggests that the inflammatory process is well-controlled, which aligns with your experience of reduced pain.

1) Regarding your question about the mild pain in your lower back when extending backward, it is important to consider a few factors. While it is understandable to want to ignore pain that does not significantly impact your daily life, it is still advisable to monitor it. Chronic pain can sometimes indicate underlying issues that may not be immediately apparent. In AS, even mild pain can be a sign of ongoing inflammation or changes in the spine that could lead to further complications if left unaddressed. It might be beneficial to discuss this symptom with your rheumatologist, especially if it changes or worsens over time.

2) Your reasoning about the relationship between normal inflammation indices and the likelihood of adhesions is partially correct. When inflammation is well-controlled, the risk of developing adhesions or further complications decreases. However, it is essential to recognize that AS can lead to structural changes in the spine and joints over time, regardless of current inflammation levels. These changes can include fusion of the vertebrae, which may not be reversible. Therefore, while your current situation is stable, it is crucial to maintain regular check-ups with your healthcare provider to monitor your condition and adjust your treatment as necessary.

In summary, while it is positive that your inflammation markers are normal and you are experiencing less pain, it is still important to remain vigilant about any symptoms you experience. Regular follow-ups with your healthcare provider can help ensure that any potential issues are addressed early, maintaining your quality of life and mobility. Additionally, engaging in appropriate physical therapy and exercises can help manage symptoms and improve function, which is particularly important in managing a condition like Ankylosing Spondylitis.

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