Could Your Symptoms Indicate Ankylosing Spondylitis?

Ankylosing spondylitis?

Hello doctor, I have been experiencing some soreness in my lower back lately, along with tightness and occasional pain in my left thigh, left knee, and even discomfort in my calf muscles and the soles of my feet.
These symptoms seem to come and go.
I have had similar issues in the past, but they have resurfaced recently.
Additionally, when I turn my neck to the left or look down to the left, I also feel tightness and pain.
An MRI previously indicated a herniated disc with nerve compression, which also has fluctuated in severity.
Recently, it has become more noticeable.
In the mornings, I don’t feel significant tightness or pain, but I occasionally experience soreness.
I had blood tests done, and my CRP, ESR, ANA, IgA, C3, and C4 levels were all normal, but my RF was slightly above the standard range.
I would like to know if my symptoms could be indicative of ankylosing spondylitis?

Cheng, 40~49 year old female. Ask Date: 2023/07/08

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
I believe it is less likely to be ankylosing spondylitis and more indicative of symptoms related to a herniated disc.
I recommend consulting a neurosurgeon for confirmation.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2023/07/08

More Info

Your symptoms could indeed suggest the possibility of Ankylosing Spondylitis (AS), especially considering your history of back pain, stiffness, and discomfort in various joints. AS is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints, which connect the spine to the pelvis. It is characterized by chronic pain and stiffness, particularly in the lower back and hips, and symptoms often improve with physical activity and worsen with rest.

The symptoms you describe, such as lower back pain, tightness, and occasional pain radiating to your left thigh and knee, align with common presentations of AS. The fact that you experience these symptoms intermittently, along with stiffness in the neck when turning, further supports this possibility. Morning stiffness is also a hallmark symptom of AS, although you mentioned that it is not always pronounced in your case.

Your previous MRI findings of a herniated disc causing nerve compression could complicate the picture, as disc issues can also lead to similar symptoms. However, the presence of RF (Rheumatoid Factor) slightly above the normal range may indicate an autoimmune process, which can be associated with various rheumatic diseases, including AS.

In diagnosing AS, doctors often look for specific clinical features, including:
1. Age of Onset: AS typically begins in late adolescence or early adulthood.

2. Family History: A family history of AS or related conditions can increase the likelihood of diagnosis.

3. HLA-B27 Antigen: Testing for this antigen can be helpful, as a significant percentage of individuals with AS test positive for it.

4. Imaging Studies: X-rays or MRI can reveal changes in the sacroiliac joints or spine characteristic of AS.

Given your symptoms and the fact that you have already undergone blood tests (CRP, ESR, ANA, IgA, C3, C4) that returned normal, it would be prudent to follow up with a rheumatologist. They may recommend further testing, including HLA-B27 testing and possibly imaging studies to assess for sacroiliitis or other changes associated with AS.

In the meantime, consider engaging in regular physical activity, which can help alleviate stiffness and improve mobility. Physical therapy may also be beneficial in managing your symptoms and maintaining spinal flexibility. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation associated with AS.

In conclusion, while your symptoms could suggest Ankylosing Spondylitis, a thorough evaluation by a rheumatologist is essential for an accurate diagnosis and appropriate management plan. Early diagnosis and treatment can significantly improve outcomes and quality of life for individuals with AS.

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