Managing Ankylosing Spondylitis: Pain Relief Strategies and Concerns

Q: Managing Ankylosing Spondylitis: Pain Relief Strategies and Concerns

Hello Jerry： 1. Pressing on the area near the left rib close to the left nipple causes pain, and this area is less commonly affected in patients with ankylosing spondylitis. 2. Ankylosing spondylitis has varying degrees of activity and different affected areas

Ankylosing Spondylitis

Hello Doctor: I have been diagnosed with ankylosing spondylitis since my university days and have been taking anti-inflammatory medication for a long time.
I previously took Celebrex (an immunomodulator), but my doctor later advised me to stop.
Currently, I only take one Mobic 15 mg tablet daily.
Since I am studying abroad, it is inconvenient for me to see a doctor, and I have two questions I would like to ask.

First, sometimes I experience pain near the ribs close to the sternum, which I understand may be caused by ankylosing spondylitis.
However, I have noticed that for a long time, there has been significant pain on the left side of my ribs near the armpit when pressed or bumped.
Can patients with ankylosing spondylitis also experience pain in that area? Specifically, I am referring to the area around the third and fourth ribs below the armpit, where there is also costal cartilage, right? In other words, it is painful when pressure is applied to the ribs near the left side of the nipple, while the right side feels relatively fine.
My second question is, even though I take one anti-inflammatory medication daily, it does not mean that I am pain-free.
For the past week or two, I have been experiencing pain in my right hip joint, to the extent that I can barely walk, and sitting or lying down is problematic.
Even after taking the anti-inflammatory medication, the pain persists.
I know that the maximum daily dose of Mobic is 15 mg, and I am cautious not to exceed that within 24 hours.
I might take an additional Tylenol, but it does not provide much relief.
What should I do in this situation? Despite taking anti-inflammatory medication, the improvement in pain is not very significant.
Thank you for your assistance, Doctor.

Jerry, 30~39 year old female. Ask Date: 2015/12/10

Dr. Zeng Guosen reply Internal Medicine

Hello Jerry:
1.
Pressing on the area near the left rib close to the left nipple causes pain, and this area is less commonly affected in patients with ankylosing spondylitis.

2.
Ankylosing spondylitis has varying degrees of activity and different affected areas at different times; it is not treated with a single medication throughout.
Regular monitoring of inflammatory activity indices and X-rays (including the sacroiliac joints, spine, and painful joints) should be conducted.
If the issues you mentioned arise, it is advisable to seek medical attention rather than solely relying on painkillers.

Thank you for your question.

Reply Date: 2015/12/10

More Info

Managing Ankylosing Spondylitis (AS) can be challenging, especially when dealing with persistent pain despite medication. Your situation raises two important concerns: localized pain near the ribs and ineffective pain management with your current medication regimen.

Understanding Pain in Ankylosing Spondylitis
1. Localized Rib Pain: It is not uncommon for patients with AS to experience pain in areas beyond the spine, including the ribs and chest. The inflammation associated with AS can affect the costovertebral joints (where the ribs meet the spine) and the costosternal joints (where the ribs meet the sternum). This can lead to pain in the chest area, including the region you described near the left side of your ribcage. The pain you feel when pressing on the area may be due to inflammation of the costal cartilage, known as costochondritis, which is common in AS patients.
2. Pain Near the Axilla: The area you mentioned, near the third and fourth ribs under the armpit, does contain rib cartilage and is susceptible to inflammation. AS can lead to changes in posture and spinal alignment, which might contribute to discomfort in these areas. It’s important to differentiate between pain caused by AS and other potential causes, such as muscle strain or even referred pain from other structures.

Pain Management Strategies
1. Medication Adjustment: While you are currently taking Mobic (meloxicam), which is a non-steroidal anti-inflammatory drug (NSAID), it may not be sufficient for managing your pain effectively. If you find that the pain persists despite taking the maximum recommended dose, it is crucial to consult a healthcare professional about adjusting your treatment plan. This could involve switching to a different NSAID or considering other classes of medications, such as disease-modifying antirheumatic drugs (DMARDs) or biologics, which can provide more comprehensive control of inflammation.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can guide you through exercises specifically designed to improve flexibility, strengthen the muscles around your spine and pelvis, and help maintain good posture. This can alleviate some of the pain and discomfort associated with AS.

3. Heat and Cold Therapy: Applying heat to the affected areas can help relax muscles and reduce stiffness, while cold packs can help reduce inflammation and numb sharp pain. Alternating between heat and cold may provide relief.

4. Lifestyle Modifications: Regular exercise is crucial for managing AS. Low-impact activities such as swimming, walking, or cycling can help maintain mobility and reduce stiffness. Additionally, practicing good posture and ergonomic adjustments in your daily activities can help minimize strain on your spine and ribcage.

5. Alternative Therapies: Some patients find relief through complementary therapies such as acupuncture, massage, or yoga. These approaches can help manage pain and improve overall well-being.

6. Monitoring Symptoms: Keep a detailed record of your pain levels, triggers, and any other symptoms. This information can be invaluable when discussing your condition with a healthcare provider, especially if you are unable to see a specialist regularly.

Conclusion
In summary, while Ankylosing Spondylitis can lead to significant discomfort, especially in areas like the ribs and hips, there are various strategies to manage pain effectively. It is essential to work closely with a healthcare provider to tailor your treatment plan to your specific needs, considering both medication adjustments and non-pharmacological interventions. If your pain continues to be unmanageable, seeking a referral to a rheumatologist or a pain management specialist may provide additional options for relief. Remember, you are not alone in this journey, and there are resources and support available to help you manage your condition effectively.

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