Is ankylosing spondylitis causing my chronic lower back pain?

Question

Hello doctor.

I have been dealing with chronic lower back pain for years, and now I am worried that it might be something like ankylosing spondylitis. What are the main early symptoms of ankylosing spondylitis, and how is it confirmed? I do not want to ignore it if there is a chance that it could be ankylosing spondylitis, but I am also unsure if I am overthinking it. Is there any specific testing I should ask for to get a clear diagnosis? I just want to make sure I am taking the right steps to find out.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Ankylosing spondylitis (AS), is a condition that often begins with pain and stiffness in your lower back. Here is a brief overview of the early symptoms and how AS is diagnosed, so you can know what steps to take.

Early Symptoms of Ankylosing Spondylitis (AS) are:

Chronic lower back pain typically starts in your lower back and may worsen at night or early in the morning. The pain is usually not relieved by rest and may improve with exercise or movement.
The morning stiffness lasts more than 30 minutes, particularly in the lower back or hips. The stiffness often improves with physical activity throughout the day.
Pain in the sacroiliac joints commonly affects your sacroiliac joints (where the spine meets the pelvis), causing pain in the buttocks or hips.
Limited flexibility over time, pain, and inflammation may reduce spinal flexibility, causing difficulty in bending or straightening the back.
Pain can also affect other joints like the shoulders, knees, and ribs. In some cases, eye inflammation (iritis) may also occur.
A family history of AS or other autoimmune diseases increases the likelihood of developing the condition, though it can occur without a family history.

AS can be diagnosed by:

Your doctor will take your detailed history, focusing on the onset of back pain, its duration, and any other symptoms like morning stiffness or joint pain. A physical exam will test your spine mobility, posture, and sacroiliac joint tenderness.
X-rays of the pelvis or lower back may show early signs of AS, such as inflammation in the sacroiliac joints or changes in bone structure. However, early-stage AS may not always show clear findings on X-rays.
MRI (magnetic resonance imaging) is more sensitive than X-rays and can detect early inflammation in the sacroiliac joints and spine before visible bone changes occur. MRI can help identify the soft tissue changes seen in AS, even in the early stages.

Blood tests:

A positive HLA-B27 test increases the likelihood of AS, but not everyone with AS will test positive, and not everyone who tests positive will develop AS.
Tests like CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) measure inflammation in your body, which can be elevated in AS.

I would suggest:

Consult a specialist
MRI and X-rays
HLA-B27 Test

It is important not to overthink it, but also not to ignore persistent lower back pain, especially if it is accompanied by morning stiffness and other symptoms. While AS can be a long-term condition, with the right management (including medication, physical therapy, and exercise), people can often maintain good mobility and quality of life. The key is early detection and treatment, so if you are concerned, it is a good idea to see your doctor and explore these tests.

I hope this helps.

Thank you.