Could I Have Ankylosing Spondylitis? Symptoms and Diagnosis - Internal Medicine

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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 is characterized by chronic pain and stiffness in the back and hips, which can lead to a progressive loss of mobility. Your symptoms, including persistent low-grade fever, pain in the lower back and hips, stiffness after prolonged periods of inactivity, and pain in large joints, are indeed suggestive of AS, even though your HLA-B27 test result was negative.

The diagnosis of AS is often challenging, as not all patients test positive for the HLA-B27 antigen. In fact, about 5-10% of the general population is HLA-B27 positive, and many individuals with AS may not have this marker. Therefore, a negative HLA-B27 test does not rule out the possibility of AS. The presence of inflammation in the sacroiliac joints, as indicated by your imaging studies, is a significant finding that supports the diagnosis.
The symptoms you describe, such as persistent pain in the lower back and hips, stiffness after rest, and pain that worsens with inactivity, align with the typical presentation of AS. Additionally, the fact that your symptoms have been ongoing for over six months and have progressively worsened is consistent with the chronic nature of this condition. The involvement of large joints and the presence of chest pain may also indicate that the disease is affecting other areas, which is not uncommon in AS.

In terms of management, it is crucial to address both the pain and the underlying inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain and reduce inflammation. You mentioned that you are currently taking pain medication and an immunosuppressive drug, which suggests that your healthcare provider is taking a proactive approach to manage your symptoms. Physical therapy and regular exercise are also essential components of treatment, as they can help maintain flexibility and improve overall function.

It is important to continue monitoring your symptoms and communicate any changes to your healthcare provider. If your pain continues to worsen or if you develop new symptoms, further evaluation may be necessary. This could include advanced imaging studies such as MRI, which can provide more detailed information about the condition of your spine and joints.

In conclusion, while your negative HLA-B27 test complicates the diagnosis, the combination of your symptoms and imaging findings raises a strong suspicion for Ankylosing Spondylitis. It is advisable to maintain an open dialogue with your healthcare provider regarding your symptoms and treatment options. Early diagnosis and intervention can significantly improve the quality of life for individuals with AS, so do not hesitate to seek further evaluation if needed.