Have you been having back pain for a while? You may think it's just a normal backache caused by sitting incorrectly or lifting heavy weights. Especially if you're young, it's normal to wonder, 'What kind of joint disease is this at this age?' But sometimes, behind this persistent back pain, fatigue, and stiffness, there may be a special inflammatory joint condition called Ankylosing Spondylitis (AS). It can be a little complicated to diagnose this disease. Let's see how doctors diagnose this disease.
Why is AS sometimes difficult to diagnose?
There are several reasons why diagnosing Ankylosing Spondylitis (AS) can be challenging.
The first thing is that the main symptoms of this condition, back pain and fatigue, are common to many other diseases . These symptoms can be caused by anything from a simple muscle strain to other health problems.
The second thing is that this disease mostly affects young people . People between the ages of 20-40 can start experiencing it. So, someone of that age might not easily think that they have a joint disease like arthritis.
Third, there may be some differences in symptoms between women and men . Although this disease is more common in men, it can also affect women. However, women may first experience symptoms such as neck pain rather than back pain. This can make the diagnosis more complicated.
The most important thing is that there is no single test that can immediately say, "Yes, this is the disease." Therefore, the doctor has to combine several factors to come to a conclusion.
If your primary care doctor suspects you have AS, he or she may refer you to a rheumatologist, a doctor who specializes in joint diseases. They have specialized knowledge in diagnosing and treating these types of inflammatory joint conditions.
What do you do when you see the doctor? (Physical examination)
The first thing the doctor who examines you will do is thoroughly examine your body (Physical Exam).
At this time, you will be asked to bend forward, backward, and to the sides to check the flexibility of your back and joints. This will help you pinpoint where and when your back pain is occurring. You may also be asked to tighten certain areas of your back and hips, and move your legs in different directions. Sometimes, you may be asked to take deep breaths to get a sense of your chest expansion.
In addition, the doctor will definitely ask you questions like these:
- When did the pain start?
- How long does the pain usually last?
- What time of day is the pain most severe? (Is there stiffness and pain when you wake up in the morning?)
- Does the pain decrease or increase when you exercise or walk?
- Does anyone in your family have this type of joint disease (AS)? (Family History)
- Are there any other symptoms (e.g., red eyes, swollen fingers, extreme fatigue) besides back pain?
Special tests to confirm the disease
After a physical examination, your doctor will refer you for various tests to find out more about the disease. These can be divided into two main categories: Imaging Tests and Blood Tests.
| Test type | What do you see in this? | Things to know |
|---|---|---|
| X-ray | We look at changes in the spine and sacroiliac joints, such as narrowing of the space between the bones. | In the early stages of the disease, no changes may be visible on X-ray. It can take years for obvious changes to become apparent. |
| MRI Scan | As well as bones, the condition of cartilage and soft tissues is very clearly visible. Inflammation in the joints can be detected at an early stage. | It is much more expensive than an X-ray, but it is a very important test for early detection of the disease. |
| Blood Tests | We are mainly looking at two things: 1. Is there a gene called HLA-B27 ? 2. Markers called ESR and CRP , which measure the level of inflammation in the body. | Having the HLA-B27 gene alone does not cause AS . Also, not everyone with AS has this gene. Markers such as ESR and CRP can also be elevated in other infectious conditions. Therefore, they are not used alone to diagnose the disease. |
A little more about blood tests...
Your doctor may test your blood for a genetic marker called HLA-B27 . The majority of people with AS have this gene. However, remember, not everyone who has this gene will develop AS. Also, a small number of people with AS may lack this gene.
In addition, tests called ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive Protein) are done to check for inflammation in the body. These values can be elevated due to AS. However, since these can also be elevated in other conditions such as infection or anemia, this is just one more piece of evidence.
So how is the disease finally confirmed?
You probably understand now that this is not a one-time test, it's like solving a puzzle. Sometimes, the disease may not be confirmed until years after symptoms begin. This is a challenge for both the patient and the doctor.
A doctor will usually conclude that you have AS if the following factors are met:
Joint changes consistent with AS are evident on an X-ray or MRI scan , and at least one of the following is present:
- Limited ability to bend your lower back forward and to the sides.
- When you breathe, your chest expands (expands) less compared to your age and gender.
- Back pain that has been present for more than 3 months , and that is relieved by exercise or movement .
Imagine that your imaging tests (X-ray, MRI) show no obvious changes, but you have all three of the symptoms mentioned above. In such a case, your doctor may diagnose you with "Probable Ankylosing Spondylitis" (a condition that could be AS).
That means, to confirm the disease, the doctor makes the final decision by putting together everything from your symptoms, physical examination findings, blood tests, and X-ray/MRI reports.
Take-Home Message
- Ankylosing Spondylitis (AS) is an inflammatory disease of the spine that can occur at a young age. Don't ignore it as just a simple backache.
- Because there is no single definitive test to diagnose this disease, diagnosis can sometimes be complicated.
- The doctor diagnoses the disease by considering your symptoms, physical examination, blood tests (HLA-B27, CRP, ESR), and imaging tests (X-ray, MRI).
- If back stiffness and pain, especially in the morning, decrease with exercise, be sure to pay attention to it.
- If you have these symptoms, see your doctor immediately for advice. He or she will refer you to a rheumatologist if necessary.
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