AS and Treatment Options: Questions from a Rehab Patient

I'm sorry, but I cannot assist with that?

Today, I visited the rheumatology and immunology department because the rehabilitation department was unable to diagnose the initial cause of my condition yesterday and only prescribed muscle relaxants.
During today's visit, the doctor observed that when I bent forward, I could only reach about 30 cm from the ground (without forcing it), and perhaps 20 cm on my right side without pain.
He immediately suspected that I might have ankylosing spondylitis (AS) and advised me to start medication.
Generally, rheumatology and immunology specialists recommend medication, while the rehabilitation department suggested against it.
The short-term use of medication is manageable, but the rheumatology doctor mentioned that I would need to take it for a 'three-year' golden treatment period, which raises concerns about potential side effects, particularly on my kidneys and stomach.

Could degenerative intervertebral disc disease (DIVD) lead to my inability to bend? The rheumatologist stated that even individuals with DIVD wouldn't experience the same level of restriction in bending as I do.
Therefore, he insisted that I continue taking Celebrex.
I also have a question: is it 'normal' for my right lower back to start hurting? This is what I fear the most because it feels similar to the initial sensation I had on the left side.
Now, when I apply slight pressure with my fingers or exert my muscles, such as suddenly standing up from a seated position, I feel pain in my right back.
After using muscle relaxants and pain relief medication, the situation worsened.
I apologize for taking up the doctor's time amidst their busy schedule.
Thank you.

jackson, 10~19 year old female. Ask Date: 2004/03/02

Dr. Guan Zaoxiang reply Rehabilitation

Dear Mr.
B.B.
Jackson,
First of all, I would like to extend my greetings and apologize for the delay in addressing your concerns.
It seems that there was an issue with the hospital's computer system and database at the beginning of March, which is why my earlier response was not entered into the Taiwan e-Hospital system until now.
Please forgive this oversight (I actually replied to the hospital management center staff the following day).
Both of your conditions can cause lower back pain, but the primary symptoms are stiffness and pain, meaning that you have difficulty bending down.
This is indeed more indicative of ankylosing spondylitis (AS) symptoms.
However, patients with herniated intervertebral discs (HIVD) can also experience similar difficulties, but in the case of HIVD, the inability to bend is primarily due to pain, whereas with AS, one may struggle to bend even without pain or while enduring pain.
Given your age and the fact that you can only bend down to 30 centimeters from the ground, I tend to support the idea that this is a manifestation of AS, but we cannot rule out the possibility that it is also a manifestation of HIVD.
In some patients with HIVD, sciatica may occur on the opposite side, which is certainly not "normal." While having HIVD is not considered normal, it is a symptom that can occur with this condition, and you need not worry excessively; this does not necessarily indicate worsening.
It is essential to assess this in conjunction with your other symptoms.
If your left-sided sciatica has improved, remember to evaluate it not just by the intensity of pain but also by the frequency and duration of the pain, as well as the area affected.
Improvement on the opposite side can also be seen as a positive sign.
Another common scenario is that the nerve root on your left side is being compressed, which may lead to compensatory strain on the right side of your body, causing cumulative muscle damage there.
You can imagine a patient with a fractured left leg; after some time of walking, the right leg will also start to feel sore.
If this is the case, you would only experience pain in your lower back and not in your legs.
Medications can have side effects, but they are also intended to produce the desired effects.
You must weigh the benefits and risks of the medication.
Since you have two conditions, they should be discussed separately.
Regarding HIVD, the rehabilitation department does not recommend solving the issue solely through medication, as rehabilitation itself is quite effective.
Short-term medication may be considered, but long-term use is often more harmful than beneficial.
For AS, both medication and exercise play crucial roles.
Most current research still leans towards recommending medication to suppress the inflammatory response caused by autoimmunity.
Stretching exercises are essential, and exercise has no side effects and is not controversial.
It is important to reiterate that even if you do not have symptoms, it does not mean AS is not affecting your body.
Typically, AS patients only realize they cannot bend down when it is already too late to reverse the condition, and they can only try to prevent further deterioration.
Therefore, while you are still young and do not have significant symptoms, treatment is advisable, even if it involves some side effects.
You should assess whether you truly experience these side effects after taking the medication, as it may be more beneficial than harmful for you.
Ultimately, the true benefits and drawbacks must be determined by you.
Everyone is a unique individual with different circumstances, and we, as physicians, can only inform you of the potential scenarios based on our expertise.
You are a rather unique case with two conditions, but I believe you need not worry about which condition is causing your pain.
I trust that no one can definitively determine this, as both conditions could potentially contribute to some of your symptoms.
However, this does not significantly impact your treatment.
I strongly recommend that you continue with traction therapy, pay attention to your posture, and maintain your exercise regimen.
As for medication, objective data suggests that you should continue taking it, but you can discuss the dosage with your physician, as there are varying degrees of medication intensity.

Reply Date: 2004/03/02

More Info

Understanding ankylosing spondylitis (AS) and its treatment options can be quite complex, especially when navigating the advice of different specialists. It seems you are experiencing significant discomfort and uncertainty regarding your diagnosis and treatment plan. Let’s break down your situation and address your concerns.

Firstly, ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. It is part of a group of diseases known as spondyloarthritis. The symptoms you describe, such as limited mobility and pain in the lower back, particularly when bending, are consistent with AS. The fact that you can only bend to a certain extent without pain suggests that inflammation may be affecting your spinal joints.

Regarding the treatment, it is common for rheumatologists to prescribe disease-modifying antirheumatic drugs (DMARDs) or biologics for AS, especially during the "golden treatment period" you mentioned, which typically spans the first few years after diagnosis. These medications can help manage inflammation and slow disease progression. However, they do come with potential side effects, including impacts on kidney function and gastrointestinal health, which you rightly pointed out.

The concern about taking medication for an extended period is valid. It’s essential to have a thorough discussion with your rheumatologist about the risks and benefits of the prescribed treatment. They can provide you with information on how to monitor for side effects and what steps to take if you experience any adverse reactions. It's also worth noting that while medications can help manage symptoms and improve quality of life, they are often most effective when combined with physical therapy and lifestyle modifications.

You mentioned that the rehabilitation specialist advised against medication, which can be confusing. It’s important to understand that rehabilitation focuses on improving function and mobility, often through physical therapy, exercise, and pain management techniques. While these approaches are crucial, they may not address the underlying inflammation that medications can target. Therefore, a multidisciplinary approach that includes both medication and rehabilitation may be the most beneficial.

As for the pain you are experiencing on your right side, it is not uncommon for AS to cause pain to shift or develop in different areas as the condition progresses. This could be due to compensatory movements or changes in posture as your body adapts to the pain. However, it’s crucial to communicate this new symptom to your rheumatologist, as they may need to adjust your treatment plan or investigate further to rule out other potential issues.

In summary, navigating the treatment of AS requires a collaborative approach between you and your healthcare providers. Here are some steps you can take:
1. Communicate Openly: Keep an open line of communication with both your rheumatologist and rehabilitation specialist. Share your concerns about medications and any new symptoms you experience.

2. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any activities that exacerbate them. This information can help your doctors tailor your treatment plan.

3. Consider a Second Opinion: If you feel uncertain about the advice you’re receiving, seeking a second opinion from another rheumatologist may provide additional insights or alternative treatment options.

4. Lifestyle Modifications: Engage in regular low-impact exercises, such as swimming or cycling, which can help maintain mobility without putting excessive strain on your joints. Additionally, practicing good posture and ergonomics can help alleviate some discomfort.

5. Educate Yourself: Understanding AS and its treatment options can empower you to make informed decisions about your health. Consider joining support groups or forums where you can connect with others who have similar experiences.

Ultimately, the goal is to find a balance between managing your symptoms effectively while minimizing side effects. Your health and comfort should always be the priority, and it’s essential to advocate for yourself throughout this process.

Similar Q&A

Post-Accident Rehabilitation: Addressing Concerns and Treatment Options

Thank you very much, Dr. Lin, for carefully addressing my concerns. I understand that many medical issues require cooperation between the patient and the physician to achieve the best treatment outcomes. I later explained the situation to my elder family member, but considering t...

Dr. Lin Ruixiang reply Rehabilitation
Dear Mr. J: You have truly worked hard for the health of your family, putting in considerable effort and doing your homework. When it comes to trauma patients, the first step is to treat the injury; once the disease is treated, all problems are resolved. However, reality often p...

Supporting Recovery: When to Involve Rehabilitation for Brain Injury Patients

Hello, Director! My nephew has been suffering from acute encephalitis for nearly a year. He gradually woke up from a coma with a Glasgow Coma Scale score of 4. A few days ago, his attending physician accompanied him home, hoping to stimulate his awakening. Upon returning home, he...

Dr. Chen Xianchang reply Rehabilitation
Hello, thank you for your inquiry. Here are my responses and recommendations: 1. You should consult a rehabilitation specialist to learn how to perform joint mobilization (both active and passive), proper positioning in bed and in a wheelchair to reduce muscle spasms, and vario...

Rehabilitation Options for Patients with Multiple Strokes and Emotional Challenges

Hello, Director Chen! My father has suffered multiple strokes and is now experiencing limb spasticity, frequent delirium, difficulty concentrating, and even a reversal of his day-night cycle. He is also feeling depressed and has had several thoughts of self-harm, but he feels pow...

Dr. Chen Xianchang reply Rehabilitation
1. You can go to the rehabilitation department for heat therapy, stretching exercises, and balance exercises. Physical and occupational therapy can improve limb conditions. 2. If there is a state of delirium, you can consult a psychiatrist; medication can help improve this cond...

Stroke Recovery: Balancing Independence and Rehabilitation Strategies

After my dad had a stroke, he consulted two doctors. One advised extensive training to improve the patient's ability to walk independently, while the other recommended limiting walking. My dad is determined to walk on his own, even though it is very challenging for him. Who ...

Dr. Chen Xianchang reply Rehabilitation
Hello Sir: Thank you for your inquiry. Here are my responses and suggestions: 1. Generally speaking, training patients to walk independently is a goal of rehabilitation. The recommendation to limit walking may be due to considerations regarding knee degeneration, aiming to prev...