Is It Really Ankylosing Spondylitis? Your Back Pain

Q: Is It Really Ankylosing Spondylitis? Your Back Pain

Hello： The diagnosis of ankylosing spondylitis should be based on symptoms, physical examination, and X-ray findings. <br>A positive HLA-B27 test is a reference point, but for clinically suspicious patients, a positive HLA-B27 significantly increases the likelihood of ankylosing

Is it really ankylosing spondylitis?

Hello Doctor, I am 25 years old and have been experiencing lower back pain for nearly a year.
However, my pain is only significant when I engage the affected area, such as bending down or sitting upright.
I believe this did not occur suddenly; rather, it started last year while preparing for graduate school entrance exams.
Due to long hours of sitting and high stress, especially during the intensive courses in February and March, I experienced considerable muscle pain in my back after attending around six hours of classes a day, followed by continued studying.
This led to the onset of chronic lower back pain.
However, I do not experience "severe morning pain" and actually feel somewhat better in the morning.
After a recent examination at Mackay Memorial Hospital's rheumatology department, I have some doubts about the findings.
Here are the key points from my tests:
1.
Blood test: HLA-B27 is positive, but there seems to be no family history of ankylosing spondylitis.
2.
Urinalysis showed no hematuria.
3.
X-ray results indicated spinal osteophytes, but the rheumatologist dismissed this finding and directly diagnosed me with ankylosing spondylitis.
4.
During the physical examination, the doctor asked me to bend forward and noted that my spine remained straight.
I mentioned that I can still bend quite well, to which he replied that I am bending from my pelvis.
However, information I found online suggests that patients with ankylosing spondylitis typically cannot bend at all.
I was prescribed anti-inflammatory pain medication (Loxoprofen) for two months, but I do not find it very effective, which leaves me confused.
I am not unwilling to face the reality of my condition, but since I have not undergone an MRI, I still have some uncertainties.
Given that I have a positive HLA-B27 result and elevated inflammatory markers, I am unsure whether I should seek further evaluation at another hospital or if I should accept the current diagnosis.
I would appreciate your opinion on this matter.
Thank you.

JEFFERT, 20~29 year old female. Ask Date: 2007/03/10

Dr. Lin Xiaoyi reply Orthopedics

Hello: The diagnosis of ankylosing spondylitis should be based on symptoms, physical examination, and X-ray findings.
A positive HLA-B27 test is a reference point, but for clinically suspicious patients, a positive HLA-B27 significantly increases the likelihood of ankylosing spondylitis.
Without a physical examination of the patient, it is difficult to diagnose ankylosing spondylitis, and the diagnosis of rheumatic diseases often requires long-term observation for confirmation.
Therefore, it is best to consult a trusted physician for long-term follow-up and treatment.
Additionally, regarding the four points you mentioned, I will briefly summarize as follows: 1.
Only 2-10% of patients who are HLA-B27 positive will develop the disease; of course, those with a family history have a higher chance, but studies show that only about 30% of patients with a family history will actually develop it.
2.
IgA nephropathy and urinary tract inflammation, which may be related to ankylosing spondylitis, can present with hematuria, but this is not common among patients with ankylosing spondylitis.
3.
It is not easy to see sacroiliitis on X-rays, especially in the early stages of the disease, as interpretations can vary based on imaging conditions and personal perspectives.
4.
In the early stages of ankylosing spondylitis, most patients do not have issues with spinal mobility, so the ability to bend does not rule out ankylosing spondylitis.
Wishing you good health.
Lin Hsiao-Yi, Department of Rheumatology and Immunology, Taipei Veterans General Hospital.

Reply Date: 2007/03/10

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness in the back. Your situation, as described, raises several important points that warrant further exploration and understanding.

Firstly, the presence of HLA-B27 positivity is significant. This genetic marker is commonly associated with AS, but it is important to note that not everyone who tests positive for HLA-B27 will develop the condition. In fact, a substantial number of people with this marker remain asymptomatic. The absence of a family history of AS also suggests that while you may have the genetic predisposition, it does not guarantee the development of the disease.

Your symptoms of lower back pain, particularly when bending or sitting, could indeed be indicative of AS, but they are not definitive on their own. The fact that you do not experience significant morning stiffness or pain, which is a hallmark symptom of AS, is noteworthy. Patients with AS often report that their pain improves with activity and worsens with rest, particularly after prolonged periods of inactivity, such as sleeping. Your description of feeling better after sitting up rather than worse could suggest that your pain may be related to muscle strain or postural issues rather than inflammatory changes typical of AS.

The X-ray findings of spinal osteophytes (bone spurs) can occur in various conditions, including degenerative disc disease, and do not specifically indicate AS. The physical examination results, where you were able to bend without significant restriction, further complicate the diagnosis of AS. In AS, patients typically exhibit limited spinal mobility, particularly in the lumbar region, and may have difficulty bending forward.

Given your ongoing symptoms and the inconclusive nature of your current evaluations, it may be prudent to pursue further diagnostic imaging, such as an MRI of the spine. MRI can provide more detailed information about inflammation in the sacroiliac joints and the spine, which can help confirm or rule out AS. Additionally, a comprehensive evaluation by a rheumatologist who specializes in inflammatory arthritis may provide further insights.

In terms of management, if AS is confirmed, treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Physical therapy is also crucial for maintaining mobility and function. In some cases, disease-modifying antirheumatic drugs (DMARDs) or biologics may be considered if the disease is more severe or does not respond to standard treatments.

In summary, while your symptoms and lab findings raise the possibility of ankylosing spondylitis, the absence of classic symptoms and the presence of other factors suggest that further investigation is warranted. Consulting with a rheumatologist and considering an MRI could provide clarity on your diagnosis and guide appropriate treatment. It is essential to address your concerns and symptoms comprehensively to ensure the best possible outcome for your health.

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