Suspected Ankylosing Spondylitis: Symptoms and Next Steps

Q: Suspected Ankylosing Spondylitis: Symptoms and Next Steps

Hello, thank you for your inquiry. <br>Here are my responses：<br>1. <br>Do I have ankylosing spondylitis? --> It would be helpful to check for HLA-B27. <br>Your symptoms have persisted for a while, and chronic lower back pain in young individuals warrants caution regarding ankylo

Suspected ankylosing spondylitis?

Hello Doctor,
I am 28 years old.
Initially, six months ago, after a full-body adjustment, I started experiencing stiffness and pain in my back upon waking up, particularly in the upper back (with no issues in the lower back).
After stretching in the morning, it would return to normal after about an hour.
This condition persisted for two weeks, so I visited a rehabilitation clinic where the doctor initially diagnosed me with myofascial pain and prescribed Celebrex.
I was advised to return if there was no improvement after a month.
After taking the medication, I felt somewhat better, but the symptoms recurred, and I even experienced lower back pain.
A month later, I returned to the rehabilitation clinic, where the physician suggested referring me to a rheumatologist to rule out the possibility of ankylosing spondylitis.
After the rheumatologist's examination, an X-ray revealed slight inflammation in the right sacroiliac joint (a bit of whiteness, but not significant), while the spine appeared normal.
My eyes were not red, and there is no family history of ankylosing spondylitis, although my mother has osteoarthritis in her hands.
The blood test results (as mentioned by the rheumatologist) were as follows: ANA: Cytoplasmic dense fine speckled (AC-19), IgG: 1745.75 mg/dL (highlighted), IgA: 293.84 mg/dL, ESR: 8 mm/hr, hsCRP: 0.20 mg/dL.
After reviewing the results, the rheumatologist prescribed Celebrex for three months and diagnosed me with suspected ankylosing spondylitis, recommending follow-up blood tests in three months and an MRI.
Currently, my symptoms include morning stiffness in the middle to lower back after sleeping too long, which is intermittent.
I have also been experiencing chest pain for about four months, initially thinking it was related to my previous gastroesophageal reflux, but I do not have any acid reflux symptoms.
Occasionally, I experience heel pain, brief Achilles tendon pain, and alternating soreness in my buttocks, hips, and lower back.
I would like to ask the doctor:
1.
Do I have ankylosing spondylitis?
2.
If it is not ankylosing spondylitis, considering my profession as a photographer and editor, which involves prolonged sitting or labor-intensive work, could this be a work-related injury?
3.
If it is not ankylosing spondylitis, should I continue to follow up with my treatment?
Thank you for your response!

Mr. Chen, 20~29 year old female. Ask Date: 2023/09/14

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1.
Do I have ankylosing spondylitis? --> It would be helpful to check for HLA-B27.
Your symptoms have persisted for a while, and chronic lower back pain in young individuals warrants caution regarding ankylosing spondylitis.
I recommend waiting for the MRI and HLA-B27 results before your physician evaluates your condition.
2.
If it is not ankylosing spondylitis, I work as a photographer and editor, often sitting for long periods or working all day.
Could this be a work-related injury? --> Unless you are spending excessive time sitting, it is quite rare for young people to experience chronic lower back pain so easily.
Regardless of whether it is ankylosing spondylitis, I suggest you engage in regular exercise, as it can help alleviate issues related to spinal inflammation or muscle fatigue.
3.
If it is not ankylosing spondylitis, should I continue to follow up with my doctor? --> I recommend that you continue to follow up with your outpatient clinic.
At the very least, wait for the MRI and further blood tests to confirm your condition before discussing future follow-up plans with your physician.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/09/14

More Info

Understanding suspected ankylosing spondylitis (AS) can be complex, especially when symptoms overlap with other conditions. Based on your description, it seems you are experiencing a range of symptoms that may or may not be related to AS. Let’s break down your concerns and provide some insights.

1. Do you have ankylosing spondylitis?
Your symptoms, particularly the morning stiffness and pain in the back that improves with movement, are classic signs of AS. The fact that you experience relief after stretching is also indicative. The MRI findings of inflammation in the sacroiliac joint (the joint between the spine and pelvis) further support this suspicion. However, the absence of significant spinal changes on X-ray and the lack of family history of AS make the diagnosis less certain. The elevated IgG levels and the specific ANA pattern may suggest an autoimmune process, but they are not definitive for AS. It’s crucial to continue monitoring your symptoms and follow up with your rheumatologist, especially after your MRI results.

2. Could your symptoms be due to occupational hazards?
Given your profession as a photographer and editor, which often involves prolonged sitting and repetitive movements, it is plausible that your symptoms could be exacerbated by your work environment. Musculoskeletal pain, particularly in the back and neck, is common among individuals who spend long hours in sedentary positions. This could lead to muscle strain or myofascial pain syndrome, which may mimic or coexist with AS. It would be beneficial to incorporate ergonomic adjustments in your workspace, take regular breaks to stretch, and possibly engage in physical therapy focused on strengthening and flexibility.

3. Should you continue to seek medical attention if it’s not AS?
Yes, it is advisable to continue monitoring your symptoms and follow up with your healthcare provider. Chronic pain, whether due to AS or another condition, warrants ongoing evaluation. If AS is ruled out, your doctor may explore other potential causes of your symptoms, such as mechanical back pain, fibromyalgia, or other inflammatory conditions. Regular follow-ups can help track the progression of your symptoms and adjust treatment plans accordingly.

In addition to these considerations, it’s essential to manage your overall health. Stress and anxiety can exacerbate pain perception, so incorporating stress management techniques such as mindfulness, yoga, or physical activity may be beneficial. Furthermore, maintaining a healthy lifestyle with regular exercise, a balanced diet, and adequate sleep can significantly impact your overall well-being and may help alleviate some of your symptoms.

In summary, while your symptoms may suggest ankylosing spondylitis, further evaluation and monitoring are necessary to confirm the diagnosis. Occupational factors may also play a role in your discomfort, and it’s essential to address these alongside any potential underlying conditions. Regular communication with your healthcare provider will be key in managing your health effectively.

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