Ankylosing Spondylitis Diagnosis and Treatment Options

Q: Ankylosing Spondylitis Diagnosis and Treatment Options

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Am I certain that I have ankylosing spondylitis? --> Currently, the diagnosis of ankylosing spondylitis requires not only blood tests but also clinical symptoms. <br>The absence of nighttime back pain is som

Diagnosis of Ankylosing Spondylitis

Hello, doctor.
I am 42 years old and have been experiencing occasional dull pain in my sacroiliac joint for the past six months.
I have seen both orthopedic and rehabilitation specialists without any improvement.
One day, I woke up at 4 AM due to severe pain in my thoracic spine, and I then consulted a rheumatologist.
My HLA-B27 test came back positive, but my CRP, ESR, and X-ray results were all normal.
I do not experience morning stiffness or back pain upon waking.
Currently, I am taking one tablet of Voltaren daily, and I have noticed some changes in my body.
Aside from the occasional dull pain in my sacroiliac joint, I have a persistent aching sensation in my hip and femur, tenderness when pressing on my coccyx, and occasional restricted sensation near my scapula with tenderness upon palpation.

I have several questions:
1.
Can I be certain that I have ankylosing spondylitis?
2.
Does the absence of morning stiffness relate to my age, or does it indicate that the disease has not fully manifested yet?
3.
Do the changes in my body suggest that the condition is progressing?
4.
Some doctors say that taking only NSAIDs is sufficient for now, while others recommend starting biologics as early as possible to prevent severe future complications.
Which approach is more suitable for my current symptoms?
5.
If I choose not to start biologics, will my condition inevitably progress?
I apologize for the many questions, and thank you for your help.

max, 40~49 year old female. Ask Date: 2023/09/28

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Am I certain that I have ankylosing spondylitis? --> Currently, the diagnosis of ankylosing spondylitis requires not only blood tests but also clinical symptoms.
The absence of nighttime back pain is somewhat unusual, and you should discuss this with your physician.
2.
Does the absence of morning stiffness relate to my age or the fact that the condition has not yet manifested? --> Morning stiffness is just one of the clinical symptoms and not everyone will experience it.
3.
Do changes in bodily sensations indicate that the condition is progressing? --> This is not a reliable indicator.
It is best to evaluate this in conjunction with regular blood tests and clinical symptom assessments.
4.
Some doctors say that taking NSAIDs is sufficient for now, while others recommend starting biologics early to prevent future severity.
Which approach aligns better with my current symptoms? --> For mild ankylosing spondylitis, it is indeed possible to manage symptoms with anti-inflammatory pain relievers.
Biologics are generally recommended for patients with a clear diagnosis, as they are medications that also have side effects and should be used cautiously.
5.
If I do not start biologics, will the condition definitely progress? --> Not necessarily.
Regular exercise, avoiding late nights, and maintaining a stable routine can help manage the condition.
Of course, regular follow-up appointments and blood tests are also important, as some changes in the condition may be reflected in blood test results even if the patient does not experience symptoms.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.
We care about you.

Reply Date: 2023/09/28

More Info

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints, which are located in the lower back where the spine meets the pelvis. It is characterized by chronic pain and stiffness, particularly in the lower back and hips. The condition can also lead to the fusion of the vertebrae, resulting in a rigid spine over time.
Based on your description, it seems you have been experiencing symptoms consistent with AS, such as intermittent pain in the sacroiliac joint, discomfort in the hips, and pain in the tailbone and shoulder blades. The presence of the HLA-B27 antigen is a significant marker often associated with AS, although not everyone who tests positive will develop the disease. The fact that your CRP and ESR levels are normal suggests that there may not be significant systemic inflammation at this time, which is a positive sign.

1. Diagnosis Confirmation: While your symptoms and positive HLA-B27 test suggest AS, the absence of morning stiffness and significant back pain upon waking may indicate that your condition is not fully developed or may be in an early stage. AS can present variably, and not all patients will experience the classic symptoms.

2. Morning Stiffness: The absence of morning stiffness does not necessarily rule out AS. It could be related to your age or the current stage of your disease. Some individuals may not experience morning stiffness, especially if they are in the early stages or if their symptoms are mild.

3. Changes in Body Sensation: Any changes you feel after starting medication, such as NSAIDs (non-steroidal anti-inflammatory drugs), could indicate that the treatment is having an effect on your symptoms. However, it is essential to monitor these changes in conjunction with your healthcare provider, as they can help determine the progression of your condition.

4. Treatment Options: The debate between continuing with NSAIDs versus starting biologic therapy (such as TNF inhibitors) is common in managing AS. NSAIDs can be effective for managing pain and inflammation, especially in the early stages. However, biologics may be recommended if your symptoms are not adequately controlled or if there is a risk of progression. The decision should be based on your specific symptoms, response to current treatment, and overall health status. Consulting with a rheumatologist who specializes in AS can provide more tailored advice.

5. Disease Progression: If you choose not to start biologic therapy, it does not guarantee that your disease will progress. Many patients manage their symptoms effectively with NSAIDs and lifestyle modifications, including regular exercise and physical therapy. However, AS is a progressive condition, and some patients may experience worsening symptoms over time. Early intervention with biologics can help prevent long-term damage and improve quality of life, so it is worth discussing with your healthcare provider.

In summary, while your symptoms suggest AS, the absence of certain classic symptoms may indicate a less aggressive form or early stage of the disease. Regular follow-ups with your healthcare provider, monitoring your symptoms, and adjusting your treatment plan as necessary will be crucial in managing your condition effectively. Engaging in physical therapy and maintaining an active lifestyle can also help alleviate symptoms and improve your overall function.

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