Early signs of ankylosing spondylitis?

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Hi all.

I haven't got clear answers from my rheumatologist and I am a bit confused so your interpretations could help me a lot. In your opinion, am I suffering from mechanical back problems and / not possible early symptoms of AS?

Background: I was diagnosed with polyarticular JIA (seronegative) at the age of 12, treated with methotrexate and biological drug (remicade), prednisone. My condition improved significantly and for years I have been almost completely symptom free. I am HLA-B27 positive with the family history of AS.

This year however, at the age of 23, I have been experiencing neck pain and stifness, swollen index finger and overall aching and feeling 'pressure' on hand/fingers, sharp pain between shoulder blades, dull aching on low back/buttock on left side which radiates to my knee. I am not experiencing morning stifness and the aching seems to be constant regardless if I am moving or not. However, especially during the nights I am having difficulties of finding comfortable position to sleep. My blood tests have constantly come back reassuringly normal, chest x-ray normal.

However, MRI of whole spine shows  congenital inter-body ankylosis at c5/c6. Slight anterior tilting of the body of c4 and c5 and widening of the interspinous distance at c4/c5 suggesting possible instability. Fatty signal changes are present in the pedicles and pars and hyper-intense lines run transversely across the pars at L5 suggesting a chronic spondylolysis, there might be minimal spondylolisthesis.

MRI of the sacroiliac joint shows no evidence of active spondylitis. There are areas of fatty signal on the lateral aspects of both sacroiliac joints and the medial aspect of the left sacroiliac joint, may be the result of previous sacroiliitis.

I have started the methotrexte treatment again and also I have been referred to orthopaedic spinal clinic as clearly I have some mechanical issues. However, I have not given clear explanations about the appearances of the sacroiliac joints and whether it might be early AS ( I was only told that it is not active). I am getting a bit frustrated as I am not getting clear answers. 

I would appreaciate any input that might make things clearer for me.

 

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  • Posted

    Of course there isn't a typical early x-ray apperach of As. A good clinician will not rely on x-ray films to diagnosis AS. That is usually later on the disease and it may not show up at all. Non-Radiographic Axial Spondalyarthritis is new Hot Topic in rehumi field. 

    What you need to do is try a course of "prednisone" to see if your "spine / back " issue improves. If it does then you certainly have a inflmmation arthritis (AS). 

    If prednisone do not help at all then AS may not be it and future medical review is need it. 

    If prednisone does help then I would certainly ask for TNF blocker such as Humira / Enberal 

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    • Posted

      Hi, thanks for your response.

      My rheumy seems to believe that I have a relapse with the JIA. I on the other hand feel like they are taking the 'easy' way and going with the diagnosis I have been already given. At first, when the small joints symptoms started again I thought it might be a relapse as well, but now it just does not feel the same..For example, when I was first diagnosed I has multiple inflamed joints and my ESR/CRP levels were very high. Now, mainly my index finger is affected and ESR/CRP levels have come back fairly normal.

      I personally believe that the joint problems are symptoms of something else, such as AS. Also, my aunt who has been diagnosed with AS started with small joint and neck problems. However, I suppose I better trust the judgement of the professional and see how everything goes. I will definitely mention about the prednisone on my next visit but, at this stage they want to keep on the methotrexate and get the orthopedic spinal review.

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  • Posted

    I have found that Amitryptaline helps with overall nerve pain..It's not only used as an antidepressant bit is widely used for nerve pain in these types of conditions..Maybe talk to your doctor about this. I do understand and sympathise with you about not being able to get comfortable at night in order to get restful sleep. The medication I am on does help with that also. I tend to be nocturnal nowadays but catch up on sleep at odd hours, but I would much rather be alseep when everyone else is....lol. You could also try a foam overlay on your mattress..it helped me.

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    • Posted

      Hi Gloria.

      That is interesting, I have never heard the use of amitriptyline for nerve pain. I will keep it on mind especially, if it can improve the quality of my sleep..But first I will wait for the orthopedic spinal review and see what they will suggest.

      I have found that using electric blanket and putting a pillow under my legs also helps a bit. Sometimes I also sleep without a pillow as it feels comfortable but, I am not sure ifit actually helps orcan make things worse. It is another thing I need to ask from my doctor.

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    • Posted

      Hi Matilda, just another thought, I have a very soft squishy pillow for my neck, I made it myself out of an old down filled pillow. I can wriggle it around to fit nicely into my neck and take it everywhere with me, even in the car. The roads where I live are broken and potholed so when I have a flare up I can put it between my neck and the headrest on the car seat to buffer any bumps...Also sleep with a long pillow between my thighs...which really helps. Using an electric blanket here would be far too hot but I have a wheat hot pack which goes in the microwave to heat up..it's great for very sore spots. I think I am the only person in Indonesia who owns a hot water bottle of the old fashioned kind...and use it sometimes when pain is bad. We have a product here called Salon Pas..which is a sort of plaster impregnanted with menthol, methyl Salicylate and camphor, it helps me and if you can get it do try it. Here the local people also use it for toothache and you can tell if someone is suffering pain as you see the "stickers" on them. It is very cheap to buy here only costing a dollar or so for a packet of ten...but I am not sure you can buy it worldwide...check on the "net" which may be able to direct you to where you can get it. Let me know how you go with that.

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