Could this be ankoloysing spondilitis?

Hi there,

A bit of background:

I'm 34, Male , White from UK. I've had back pain for about 10 years now.

This back pain came on gradually without an specific cause / impact injury. It's hard to pinpoint exactly where the pain is - but it definitely came from around the L5/S1 area and felt right in the core of my body....so as difficult to put my finger on exactly the source. I feel this in the lower lumbar spine and also somewhat in to the buttocks

I have no pain when staying still in any position (e.g. sitting). Nor is my pain noticeably worse in the morning or evening. I just experience my pain when making transitional movements that involve the lower spine (e.g. bending/twisting).

This pain continued everyday for 8 years - sometimes slightly better - sometimes slightly worse - but always there. It was just more of a nuisance more than something that was really bothering me or limited my movements in anyway. I'd say that over this 8 years it probably got slightly worse.

I'm a very sporty person - playing a lot of racket sports. About 2 years ago - I overplayed badminton and the next day my back completely seized up. I couldn't bend at all the next day so went to see a physio who informed me I probably "irritated a disc" - told me to rest.

I rested for a few days and my pain improved but never went back to the level it was before - and was definitely more of a nuisance to me.

Move on to this last year - my back pain took a significant turn for the worse. Over the last year - the pain is no longer confined to my low back and buttocks... but I now also get sharp pains in to both hips and in to the groins when making these transitional movements.

I'd now say i'm significantly functionally impaired now as just bending over to pick something up or turning over in bed causes very sharp pains all over my pelvic area.

However, whilst always there - I can't see a logic to the severity of my pain. Sometimes the pain in my hips disappear for a few hours then come back - or switch hips etc. It's almost random and not related to any activity I am doing.

Having said that - if I do play sport or place load through my back (e.g. gardening). I am always noticeably worse the next day.

Here's a list of symptoms I currently have:

• Sharp pains in hips, low back and groins when making transitional movements at hips
• These pains are all day / every day
• Pain not noticeably worse in morning/evening
• I do not have sciatic or any pain in to my legs
• Things like turning over in bed / putting on my socks or bending over to pick something up are very difficult
• I have to brace when a sneeze and also get a sharp pain when sneezing
• If i lay on my stomach for 15 minutes or so - i'm barely going to get back up in to an upright position - this is one of the worst things I can do to exasperate my symptoms.
• Ibuprofen and other NSAIDS do not help my back pain
• I've never had any conditions related to AS - e.g. uveitis / swelling in other joints in my body
• I do have a family history of inflammatory conditions - my brother has uveitis, sister has rhumatoid arthritis and I have a cousin with AS.

In terms of treatment - I've tried all 1st line treatments:

• daily stretching
• core strengthening (bird dog / plank / hip flexor etc)
• physiotherapy
• shockwave therapy
• NSAIDS
• hot cold therapy

However none of these have helped my pain levels.

In terms of investigations - i've had the following:

• MRI - this came back showing a DDD at L5/S1, with loss of disc height and a small disc bulge and also modic type 1 changes on the end plate. All other discs are in pristine condition. I also had my SIJs scanned - and it was commented on the radiology report that there were subtle changes suggestive of early sacroiliitis.

• Xray - nothing of note

• Blood work - All normal. HLA-B27 negative. All inflammatory markers within normal ranges.

I'm aware that having modic type 1 can be a painful condition which can cause symptoms similar to mine and is often resistant to treatment.

However, part of me is wondering whether I also have ankoloysing spondilitis - which is potentially what I am seeing over the last year when my symptoms got significantly worse. I think this because:

• I have a strong family history of inflammatory conditions
• A radiologist has pointed out that I have potential early sacrioilitis on my MRI
• The pain I have in to hips/groins is just so random and seems to me to be inflammatory in nature rather than mechanical

Please note that I've had a rhumatologist look at my MRI - and they said that the changes found in my SIJ were so small that they couldn't be diagnosed as sacrioilitis.

I'm not sure if that means I have to wait until more damage is caused before I can recieve this diagnosis?!!!?

Either way - i'd like your thoughts. Could I be experiencing pain due to both modic type 1 DDD and AS despite having negative inflamatory markers?

What is causing these small changes to my SIJs (not matter how small) if not AS?

I'm going to see another rhumatologist next week for a second option

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