Could I Have Ankylosing Spondylitis? Symptoms and Self-Diagnosis

Is it possible to have ankylosing spondylitis?

Hello doctor, recently I have experienced occasional heel pain after sitting for long periods (about over an hour).
I previously consulted a neurologist, and X-rays revealed osteophyte formation at the L4 and L5 vertebrae, resulting in some fusion-like appearance at L4 and L5 (the pelvis and sacrum were not X-rayed).
After undergoing rehabilitation and exercise, this issue has improved.
Although I currently do not have any significant lower back pain or morning stiffness in the spine, I am concerned about the early onset of degenerative changes in my lumbar spine at a young age and whether I might be at risk for ankylosing spondylitis.
Is there a way to self-diagnose? Additionally, when visiting the hospital for treatment, can I request a blood test for HLA-B27, and what would the cost be?

Xiao Chao, 20~29 year old female. Ask Date: 2011/11/07

Dr. Gao Jiankai reply Internal Medicine

Hello, ankylosing spondylitis often presents with chronic back pain, especially when the pain lasts for more than three months.
This should be taken seriously.
If the symptoms are only short-term, there is no need for excessive concern; however, if the symptoms recur or become persistent, it is advisable to seek medical attention.
Please continue to monitor for any morning stiffness in the lower back that improves with activity, as this is still a typical manifestation of this type of arthritis.
In addition to ankylosing spondylitis, there are other types of arthritis that may present similarly, and X-rays may show changes such as spinal fusion, so follow-up X-rays are necessary for comparison.
If the symptoms are typical, you can actually seek treatment under the National Health Insurance, so there is no need to worry about costs.
However, the most important thing is to continue exercising, as this not only helps prevent ankylosing spondylitis from worsening but also improves muscle coordination and ligament strength, reducing the likelihood of unusual aches and pains.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to support you.

Reply Date: 2011/11/07

More Info

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints, which are located at the base of the spine where it connects to the pelvis. It can lead to severe, chronic pain and discomfort in the back and hips. The condition is characterized by inflammation of the spinal joints, which can result in the fusion of the vertebrae, leading to a rigid spine.
Your symptoms, particularly the heel pain after prolonged sitting and the presence of bone spurs in the lumbar region, could be indicative of underlying issues, but they do not necessarily point directly to AS. The absence of lower back pain or morning stiffness, which are hallmark symptoms of AS, is a positive sign. However, it is understandable to be concerned about early signs of spinal degeneration at a young age.

Self-diagnosis of AS can be challenging, as it requires a comprehensive evaluation of symptoms and medical history. Here are some common symptoms associated with AS that you can consider:
1. Chronic Pain and Stiffness: Particularly in the lower back and hips, especially after periods of inactivity or in the morning.

2. Improvement with Exercise: Unlike typical back pain, AS symptoms often improve with physical activity.

3. Limited Range of Motion: Over time, AS can lead to reduced flexibility in the spine.

4. Posture Changes: Advanced AS can cause a stooped posture due to spinal fusion.

5. Fatigue: Chronic inflammation can lead to feelings of tiredness.

If you are experiencing any of these symptoms, it may be worthwhile to consult a rheumatologist, who specializes in autoimmune and inflammatory conditions. They can perform a thorough examination and may recommend imaging studies, such as X-rays or MRI, to assess the condition of your spine and sacroiliac joints.

Regarding the HLA-B27 test, this blood test can help determine if you carry a specific antigen associated with AS. While not all individuals with AS test positive for HLA-B27, a significant percentage do. The cost of the test can vary depending on your location and healthcare provider, but it typically ranges from $50 to $200. It is advisable to check with your healthcare provider or insurance company for specific pricing and coverage details.

In summary, while your symptoms may raise concerns about AS, the absence of key symptoms such as morning stiffness and lower back pain is reassuring. It is essential to discuss your concerns with a healthcare professional who can provide a comprehensive evaluation and guide you through the appropriate diagnostic tests. Early diagnosis and management can significantly improve outcomes and quality of life for individuals with AS or any other inflammatory condition.

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