Have you had back pain since you were young? Is it a strange pain that is constant, feels like your spine is made of stone when you wake up in the morning, and gets better with exercise? Maybe you have tried various treatments for it, but still haven't figured out what exactly it is? If so, this article will be very important for you. Today we are going to talk about Ankylosing Spondylitis, or AS for short.
Why is AS so difficult to diagnose?
Simply put, Ankylosing Spondylitis (AS) is a chronic inflammation of the joints of the spine and pelvis. There are several main reasons why it can be difficult to diagnose.
The first thing is that the symptoms of this disease appear very slowly . You don't feel a big difference right away. The second and most important thing is that the main symptom of this disease is back pain . Now think about it, how common is back pain? If you lift something wrong, if you sit for a long time, if you sleep in the wrong position, your back can hurt. So, many people think that this is a normal back problem.
For these reasons, studies have found that it can take up to 8 to 10 years from the time someone starts showing symptoms to be diagnosed with AS. However, early detection of the disease is crucial to maximize the effectiveness of treatment.
So, there is no single test that can confirm 100% "Do I have AS?" at once. However, a doctor uses a combination of tests to diagnose this disease, like solving a puzzle, to arrive at a conclusion.
What steps does the doctor use to diagnose the disease?
When you go to see a doctor about your back pain, he or she will follow several steps if they suspect this condition.
1. Asking you for details and physically examining you
The first thing you will do is talk to you carefully and ask about your symptoms. They will ask you in depth questions, especially about your back pain. If your back pain matches at least four of the following characteristics, your doctor may suspect AS.
| Suspicious characteristic | Description |
|---|---|
| Age | Did the cramps start before the age of 35? |
| Beginning | Did the pain gradually increase? |
| Time | Has it been going on for more than three months? |
| The effect of exercise | Does the pain decrease when you exercise or walk? |
| Morning stiffness | When you wake up in the morning, does your back feel stiff and difficult to bend for about an hour? |
In addition, the doctor will ask if anyone in your family has had this type of joint disease. This may have a genetic link. He will also check how stiff and flexible your spine is. He will check for pain when you press on your spine and other joints. Sometimes, he may even check how your chest expands (when you breathe).
2. Imaging Studies
These are tests that take pictures of the inside of the body. These are very helpful in diagnosing diseases.
- X-ray: If AS is suspected, a doctor may first order an X-ray. The sacroiliac joint, where the spine begins and connects to the hip bone, is called the sacroiliac joint. Changes in this joint are the most obvious signs of AS. Unfortunately, these changes don't become apparent on an X-ray until several years after the onset of symptoms .
- CT Scan (Computerized Tomography Scan): If nothing is clearly visible on the X-ray, but the doctor suspects AS, he or she may refer you for a CT scan. This can produce a more detailed, three-dimensional (3D) image than an X-ray.
- MRI scan (Magnetic Resonance Imaging): This is the most helpful test for diagnosing AS in its early stages. MRI does not use X-rays, but instead uses a large magnet and computer technology to see very clearly inside the body, especially in the soft tissues and joints.
- Ultrasound scan: This uses sound waves to create images. This is still being researched as a way to detect AS early.
3. Blood Tests
Your doctor may also order several blood tests, mainly to look for inflammatory markers that can indicate whether there is inflammation in the body.
Also, there is another very specific genetic test , which is the test for the HLA-B27 gene.
The important thing is this: just because you have the HLA-B27 gene in your body doesn't mean you have AS 100% of the time . But the majority of people with AS have this gene. So, if you have this gene along with your symptoms, it can be a very important clue for your doctor to make a diagnosis.
So you can see, diagnosing AS is like working as a detective. It takes a lot of evidence, not just one piece of evidence, to arrive at the right conclusion.
Take-Home Message
- Ankylosing Spondylitis (AS) cannot be diagnosed with a single test. It is a multi-step process.
- If you have had persistent back pain and stiffness since you were young, especially in the morning, don't ignore it as something normal and see a doctor.
- The sooner this disease is diagnosed, the greater the success of treatment.
- Your doctor will combine the information you provide, a physical examination, imaging tests (X-ray, MRI), and blood tests (especially HLA-B27) to arrive at an accurate diagnosis.
- Don't worry if it takes a while to get a diagnosis. This is a complex condition, so it's normal for it to take time. The most important thing is to stay in touch with your doctor and get the necessary tests done.
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