Do I have ankylosing spondylitis?
Q: I am 30 years old male employed in software industry. Since last three years I am having neck pain but now I started to have low back pain also. I underwent a lot of tests. Initially, the doctor told me that I am suffering from cervical spondylitis but he now thinks that it is ankylosing spondylitis. Could you please tell me what exactly am I suffering from?
A:Diagnosis of ankylosing spondylitis is made on clinical grounds in patients who have the following clinical symptoms: 1. Prolonged early morning stiffness in the spine (mainly lower spine) that may take up to one hour (or even more) for maximum possible improvement. 2. Alternating buttock pains. 3. Physical activity (including exercise) improves the symptoms but inactivity (taking rest) does not. 4. Nights are more painful than the day time; moreover, the second half of the night gets disturbed due to increase in back pain that comes even on turning in bed. Young people who have these symptoms (at least 2 of the 4 or more) should get a test of their genes looking for a gene called HLA B27. The catch is that there are a large number of commercial laboratories, which claim to have the facility to do this test. Unfortunately, they use a technique called ‘Flowcytometry’ for performing this test. It gives wrong results. Therefore, one must find out a laboratory that used DNA-based technique using a method called ‘Nested-PCR’. X-ray of sacroiliac joints is also very useful, but only in late stages. In early stages (less than 2 years duration), MRI of sacroiliac joint with ‘STIR’ method looking for subchondral bone oedema, is another very useful confirmatory test for sacroiliitis, a hallmark of ankylosing spondylitis. The main problem is that there are very few rheumatologists (specialists in joint diseases) in the country. Most doctors, including Orthopaedic surgeons, internists have little idea of how to make the diagnosis of ankylosing spondylitis. Therefore, I strongly recommend that take a printout of this message and find out a rheumatologist for consultation as soon as possible without wasting any more time. The earlier you are diagnosed the better it would be for long-term outcome of the disease.