Q: I am a 46 years old male. Six months back, I went for a long walk (20 km). After two weeks, I was bed-ridden. Bone scan revealed nonspecific inflammatory / degenerative changes in the regions along with polyarthritis. The test HLA B27 showed negative. MRI also showed no evidence of sacroiliitis. Hence, I was given painkillers, but there was no improvement. Presently, my neck, hand and hip movements are restricted. My doctor suspected ankylosing spondylitis and gave medicine. Kindly advise whether or not I have ankylosing spondylitis.

A:The diagnosis of ankylosing spondylitis is made on the following clinical characteristics: 1. 95% of the persons get the disease symptoms below 40 years of age, mostly below 25 years of age. 2. There is marked early morning stiffness in the lower back that takes at least 1 hour to get relieved. 3. Physical activity (including exercises) makes the discomfort disappear / improve but inactivity (taking rest) does not. 4. Second half of the night is disturbed due to severe pain in the lower back that makes it difficult even to turn in bed. Presence of these features is highly specific as well as sensitive for making a diagnosis of ankylosing spondylitis. In early stages, subchondral bone oedema is seen in the sacroiliac joints; at later stage plain x-ray (AP view of pelvis) may show irregular joint margins and/or erosions and sclerosis. HLA B27 must be done by DNA technique using ‘Nested-PCR’ methodology using latest probes (not by flowcytometry, the commonly used technique commercially - this test gives a lot of false-negative results). Under the circumstances, I would strongly recommend that you immediately contact a rheumatologist for getting a correct diagnosis and treatment.