How do I manage rheumatoid arthritis and AS?

Question

Hello doctor,

I am only 33 years old, and some mornings I literally cannot get out of bed without sitting there for 20 minutes, waiting for my joints to loosen up. I was diagnosed with rheumatoid arthritis two years ago, and last month my rheumatologist told me that I also have ankylosing spondylitis.

My CRP came back at 18, which my doctor said was high, and my RF was also positive.

How can I manage rheumatoid arthritis alongside ankylosing spondylitis at the age of 33? I feel like my body is falling apart, and I do not even know which condition I should focus on first.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Rheumatoid arthritis and ankylosing spondylitis are distinct inflammatory rheumatic diseases with different disease mechanisms. Although their coexistence is uncommon, it is possible and has been reported in the medical literature. Therefore, the diagnosis should be confirmed based on your clinical findings, laboratory tests, and imaging studies rather than on RF (rheumatoid factor) positivity alone.

Ankylosing spondylitis is classified as a seronegative spondyloarthritis, meaning that RF and Anti-CCP (anti-cyclic citrullinated peptide) antibodies are usually negative. However, a small percentage of patients with ankylosing spondylitis may have a positive rheumatoid factor, and in rare cases, rheumatoid arthritis and ankylosing spondylitis can coexist.

Your condition requires a thorough evaluation to establish the correct diagnosis. Other conditions, such as psoriatic arthritis, should also be considered, even in the absence of skin lesions, as arthritis can precede psoriasis. Degenerative sacroiliac joint disease or rheumatoid arthritis with incidental sacroiliac involvement may also need to be excluded.

Fortunately, the treatment approaches for rheumatoid arthritis and ankylosing spondylitis overlap to a considerable extent. Several medications, including tumor necrosis factor (TNF) inhibitors, are effective for both conditions when clinically indicated.

I would suggest the following investigation that needs to be ruled out:

RF (rheumatoid factor).
Anti-CCP (anti-cyclic citrullinated peptide) antibodies.
HLA-B27 (human leukocyte antigen B27).
MRI (magnetic resonance imaging) of the SI (sacroiliac) joints using STIR (short tau inversion recovery) and T2-weighted sequences.
ANA (antinuclear antibody) by IF (immunofluorescence).

Please follow up with your rheumatologist after completing the recommended laboratory tests and imaging studies. A comprehensive evaluation will help confirm the diagnosis and guide the most appropriate long-term treatment plan.

I hope this information is helpful. Please feel free to ask if you have any further questions.

Thank you.