Which Specialist to Consult for Back Pain with Family History of Ankylosing Spondylitis?

Given the family history of ankylosing spondylitis and current symptoms of back pain with an uncertain cause, you should consult a rheumatologist?

Hello Doctor: My current condition is that I tested positive for HLA-B27 (diagnosed around the age of 23 at the Veterans General Hospital in Yuan Shan and the Air Force General Hospital).
There is a family history of ankylosing spondylitis (my uncle, father, and cousin), with my uncle having severe kyphosis.
My father underwent X-ray examinations at Yang Ming Hospital, revealing adhesions in 4-5 segments of the lumbar spine (or possibly the coccyx), but it does not affect his mobility.
I have not undergone any examinations since I was 23, so I am unaware of my current status.
For the past few months, I have experienced daily symptoms of lower back pain, particularly in the area just below the rib cage in the lower back, which is very sore.
Pressing on this area elicits pain, and applying pressure results in a feeling of soreness and weakness (very achy).
Previously, my pain (possibly related to ankylosing spondylitis or not) was mostly radiating pain below the buttocks to the thighs, with deep muscle pain that did not respond to external massage or topical ointments.
Because the pain was similar to that of ankylosing spondylitis, I did not pay much attention to it.
However, recently, I have experienced almost no radiating pain below the buttocks to the thighs; instead, I wake up every morning with soreness in my lower back (mostly achy), stiffness, and difficulty moving, with pain upon any movement.
At one point, it was so severe that I couldn't bend down to let someone in the front seat.
I suspected it might be due to a hard bed, but sometimes I would suddenly have a day without pain, and napping in the afternoon would not cause pain.
Adding a soft cushion sometimes helps, but not always.
I have also tried changing pillows and elevating them, but these changes are only effective for a day, and sleeping on my side does not help either.
Regardless of how I adjust, I still wake up with lower back pain.
I have tried massages...
with no effect, and applying pain relief ointments...
well, they feel cool but are ineffective.
In the past, if I swam 1000 meters at night, I could sleep through the night without back pain, but now that effect is diminishing.
Currently, I have been self-medicating with CELEBREX (celecoxib) 100mg.
I am unsure if it is the right medication, but at least when the pain is severe, taking two pills provides good relief.
Otherwise, life is quite difficult (taking a few inexpensive pills makes me feel comfortable; no wonder everyone loves medication).
However, taking 3-4 pills daily raises concerns about whether it is good for me, and most importantly, I cannot determine if this back pain is caused by ankylosing spondylitis (it might just be lumbar muscle strain—note: I mostly sit at work and use the computer, and I do not exercise regularly).
Which specialty should I consult, and what examinations should I undergo? Thank you!

Lü Xiaogang, 30~39 year old female. Ask Date: 2008/01/25

Dr. Pan Yingda reply Rehabilitation

Basically, ankylosing spondylitis (AS) is not considered a hereditary disease.
There may be genetic and constitutional factors involved, but which chronic disease does not have some underlying predisposition? The purpose of testing is simply to confirm whether or not it is AS, right? So what comes next? The main focus is still on managing pain, correct? To diagnose AS, an X-ray is sufficient; no further tests are necessary.
Here are a few recommendations that can be helpful regardless of whether you have AS or not: 1.
Pay attention to your posture (you may need someone to help you adjust to what is considered correct posture), 2.
Avoid maintaining the same position or performing the same movement for too long, 3.
Engage in moderate exercise, 4.
Reduce excess body weight, 5.
Limit intake of dairy products, 6.
Avoid sleeping on overly soft mattresses.
You can consult a specialist in allergy, immunology, and rheumatology for medication and further diagnosis, or seek help from a rehabilitation specialist to manage pain and engage in some exercise.

Reply Date: 2008/01/25

More Info

Given your symptoms and family history of ankylosing spondylitis (AS), it is crucial to consult a specialist who can provide a comprehensive evaluation and appropriate management. The best specialist for your situation would be a rheumatologist. Rheumatologists specialize in autoimmune and inflammatory conditions, including AS, and can help determine whether your symptoms are indeed related to this condition or if they stem from other causes, such as muscle strain or postural issues.

Recommended Steps:
1. Consult a Rheumatologist: Given your HLA-B27 positivity and family history of AS, a rheumatologist can perform a thorough evaluation. They will take a detailed medical history, conduct a physical examination, and may order imaging studies to assess the condition of your spine and joints.

2. Imaging Studies: The rheumatologist may recommend X-rays or MRI scans of your spine and pelvis. These imaging techniques can help identify any changes in the sacroiliac joints (the joints connecting the spine to the pelvis) or other areas that may indicate AS. Early detection is crucial in managing AS effectively.

3. Blood Tests: In addition to confirming HLA-B27 status, other blood tests may be conducted to check for inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Elevated levels can indicate inflammation in the body.

4. Physical Therapy: Regardless of the diagnosis, physical therapy can be beneficial. A physical therapist can design a tailored exercise program to improve flexibility, strengthen the muscles supporting your back, and reduce pain. Regular exercise is essential for managing symptoms of AS and preventing stiffness.

5. Medication Management: While you are currently using Celebrex (celecoxib) for pain relief, it is essential to discuss this with your rheumatologist. They may prescribe disease-modifying anti-rheumatic drugs (DMARDs) or biologics if AS is confirmed. These medications can help manage inflammation and slow disease progression.

6. Lifestyle Modifications: Since you mentioned that your work involves prolonged sitting, consider ergonomic adjustments to your workspace. Ensure your chair provides adequate lumbar support, and take regular breaks to stand and stretch. Engaging in low-impact exercises, such as swimming or cycling, can also help alleviate symptoms.

7. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any factors that seem to alleviate or exacerbate them. This information will be valuable for your healthcare provider in making an accurate diagnosis.

Conclusion:
Your symptoms of back pain, stiffness, and discomfort, particularly in the context of a family history of AS, warrant a thorough evaluation by a rheumatologist. Early diagnosis and intervention can significantly improve your quality of life and help manage symptoms effectively. Do not hesitate to seek medical advice and advocate for your health; understanding your condition is the first step toward effective management.

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