Do you often get back pain? When you get out of bed in the morning, your back feels stiff and you can't even bend it properly for a while? Many of us write these things off as "work fatigue" or "a little back pain." However, sometimes these symptoms, especially if they start at a young age, can be more than just a simple backache. Today we are going to talk about one such condition, Ankylosing Spondylitis, or AS for short.
Why is AS a little difficult to diagnose?
In fact, there are several reasons why ankylosing spondylitis (AS) can be a bit complicated to diagnose right away.
The first thing is that the main symptoms of this condition, such as back pain and stiffness, and extreme fatigue , are also seen in many other diseases. Therefore, it is difficult for even a doctor to immediately say that this is AS.
The second thing is that this disease most often begins at a young age . Just think, when someone in their 20s or 30s says they have back pain, none of us would think it was arthritis, right? Many people think that arthritis only develops when you get older. That's why young people don't pay much attention to it.
Third, men are about five times more likely to develop AS than women. This can make it more difficult for doctors to diagnose AS in women, as the symptoms women experience can sometimes be different. For example, some women may experience neck pain before back pain.
The important thing is that there is no single test that can confirm AS. So your doctor has to put together several other methods, like solving a puzzle, to arrive at a diagnosis.
If your primary care doctor suspects you have AS, he or she will likely refer you to a specialist. This is a rheumatologist. Simply put, these are doctors who specialize in joint and inflammatory conditions like AS.
What are the diagnostic tests?
The doctor begins the diagnosis by examining you carefully. Then, depending on the need, he or she will refer you for various tests. Let's see what these steps are.
1. Physical Exam
First, the doctor will examine your body.
- You will be asked to bend in different directions. This will help you understand how much movement in your back is restricted and where the pain is.
- You can press on certain areas of your back and hip area to see if there is any pain.
- They try to move your legs in different positions .
- Your chest expansion will be measured by asking you to take a deep breath . This is because as AS progresses, the joints in the chest can also be affected, limiting the ability of the chest to expand when breathing.
In addition, the doctor will definitely ask you a few questions. Your history is very important for the diagnosis.
- When did this pain start?
- How long does the pain usually last? (Is it only in the morning? Is it all day?)
- What time of day is the pain most severe? (AS pain is often worse in the morning and when resting.)
- Does the pain decrease when you exercise or walk? (This is a very specific feature of AS.)
- Does anyone in your family have back problems or arthritis like this? (Because there is a hereditary link)
- Are there any other symptoms? (e.g., red eyes, skin problems, intestinal problems)
2. Imaging Tests and Blood Tests
After your physical examination, if the doctor needs more information, he or she may recommend tests like X-rays, MRIs, and some blood tests.
| Test type | What to expect and things to know |
|---|---|
| X-ray | This can show changes in your spine and hip joints (sacroiliac joints). However, in the early stages of AS, no changes may be visible on an X-ray. It may be several years after the disease begins when changes begin to appear. |
| MRI Scan | An MRI scan can take a clear picture of your bones as well as your soft tissues. This makes it very helpful in detecting inflammation in the joints in the early stages of the disease. However, an MRI scan is much more expensive than an X-ray. |
| Blood Tests |
|
How do you arrive at a final diagnosis?
As you can see, this is not something that can be determined with a single test. It can sometimes take years to confirm AS, as imaging and blood tests do not provide clear evidence in the early stages.
A doctor will usually confirm a diagnosis of AS if one or more of the following criteria are met:
1. If an imaging test (X-ray or MRI) clearly shows changes related to AS in the spine or hip joints, and in addition, you have at least one of the following symptoms:
- Back pain that has lasted for more than 3 months, especially if the pain is worse at rest and relieved by movement.
- If the ability to bend the lower back is limited.
- If your chest expansion when you breathe is less than expected for your age and gender.
In some cases, even if imaging tests do not show any obvious changes, if you have all three of the above symptoms (back pain, limited range of motion, and decreased chest expansion), your doctor may diagnose you with "probable ankylosing spondylitis."
Therefore, the final conclusion is reached by combining all of your symptoms, the doctor's physical examination, and other test reports.
Take-Home Message
- Ankylosing Spondylitis (AS) is a complex disease that can take some time to diagnose, so be patient.
- Never underestimate back pain, especially when you're young, that gets worse when you rest and gets better with exercise. It may not be a "normal backache."
- There is no single "magic" test to confirm AS. A diagnosis is a decision made based on your story, physical examination, and other test results.
- If you have these symptoms, don't be afraid to see your doctor and talk about it without delay. The sooner the disease is diagnosed, the better the treatment and results can be.
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