Inflammation Index and Its Impact on Adhesion in Ankylosing Spondylitis

Q: Inflammation Index and Its Impact on Adhesion in Ankylosing Spondylitis

Hello, thank you for your question. <br>Here are my responses： 1) My current index is normal, and I hardly feel any pain in my buttocks. <br>However, I do experience some discomfort in my lower back when leaning back, but it is minimal and does not significantly affect my daily l

The relationship between inflammatory markers 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 consistently taking 2 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 experience slight pain in my lower back when leaning backward (however, I do not feel it during exercise or daily activities unless I specifically lean back a lot).
I have tried taking Vectra and Humira, and I also attempted to take 4 tablets of Celebrex a day, but none of those worked.
I would like to ask the doctor: 1) Since my levels are now normal and the pain in my buttocks is almost gone, can I ignore the slight pain in my lower back that only occurs when leaning back a lot, and just continue taking 2 tablets of Celebrex daily? 2) I think this way because, since my levels are normal, the chance of adhesions in my lower back is very low.
Is my thinking correct? Thank you, Doctor.

Zhong, 20~29 year old female. Ask Date: 2023/04/03

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses: 1) My current index is normal, and I hardly feel any pain in my buttocks.
However, I do experience some discomfort in my lower back when leaning back, but it is minimal and does not significantly affect my daily life.
Can I just ignore the lower back pain that doesn't impact my daily activities and continue taking 2 Salazopyrin tablets daily? --> If the symptoms are mild and tolerable, it is indeed acceptable to not worry too much about them, but you should continue taking Salazopyrin tablets.
Please maintain a regular exercise routine, as this can further alleviate back symptoms and prevent adhesions.
In the future, there may be an opportunity to reduce or discontinue Salazopyrin.
2) I think this way because since my index is normal, the chance of adhesions in my lower back is very low.
Is my thinking correct? --> The index is just a reference; please continue to exercise regularly to reduce the chances of adhesions.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2023/04/03

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. The relationship between inflammation indices, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the symptoms of AS is crucial for understanding the disease's progression and management.

1. Understanding Inflammation Indices: CRP and ESR are markers used to assess inflammation in the body. In patients with AS, these indices can be elevated during periods of active inflammation. However, it is important to note that the presence of normal CRP levels, as you mentioned, indicates that your inflammation is well-controlled. This is a positive sign, suggesting that your current treatment regimen is effective in managing the inflammatory component of your disease.

2. Impact of Inflammation on Symptoms: The fact that your CRP levels are within the normal range and that you are experiencing minimal pain in your buttocks is encouraging. It suggests that the inflammatory processes that typically exacerbate AS symptoms are under control. However, the residual pain you experience in your lower back when extending backward may be due to mechanical factors rather than active inflammation. This is not uncommon in AS patients, as structural changes in the spine can lead to discomfort even when inflammation is managed.

3. Management of Residual Pain: Regarding your question about whether you can ignore the mild pain during backward extension, it is essential to consider the overall management of AS. While it may not significantly impact your daily life, ignoring any pain could lead to potential complications in the long run. Regular monitoring and communication with your healthcare provider are crucial. They can help you determine if any adjustments to your treatment plan are necessary or if additional therapies, such as physical therapy or specific exercises, might be beneficial.

4. Adhesion and Long-term Considerations: Your assumption that normal inflammation indices correlate with a reduced risk of adhesions is partially correct. Chronic inflammation can lead to fibrosis and adhesions in the affected joints and surrounding tissues. However, even with normal CRP levels, the structural changes associated with AS can still progress. Therefore, while your current treatment seems effective, it is vital to remain vigilant about any changes in symptoms or new pain patterns.

5. Conclusion: In summary, maintaining your current treatment with two Salazopyrin (sulfasalazine) tablets daily seems appropriate given your stable condition. However, it is advisable to continue monitoring your symptoms and maintain regular follow-ups with your rheumatologist. They can provide guidance on managing any residual pain and ensure that your treatment plan remains effective in preventing long-term complications associated with AS. Engaging in appropriate physical activity and exercises tailored to your condition can also help maintain mobility and reduce stiffness, which is essential for overall well-being in patients with ankylosing spondylitis.

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