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Ankylosing Spondylitis.

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I'm a 36-year-old female, very healthy overall, normal weight, nothing remarkable in my medical history. About a month and a half ago, I started waking up with a slightly stiff lower back, but soon after getting up, I'd limber up and be fine. Over the past 4 to 5 weeks, the morning pain and stiffness in my lower back has gotten worse. It feels like my spine doesn't want to bend. On a scale of 1 to 10, the pain is probably a 5 or 6. Once I stand up and start moving around, the pain gradually decreases (to a 2 or 3 on the pain scale), however, it doesn't fully go away. Although the pain is always in my lower back (lumbar region, just above my tailbone), sometimes I feel it more on the right side; sometimes on the left. At times it feels like a dull ache in the muscles on either side of my spine; other times it feels like maybe the spine itself is hurting. Walking and moving and standing help the pain. Sitting on a hard surface, or sitting for any length of time, makes it worse. I have no radiating nerve pain, numbness, or tingling. No bladder or bowel problems. I finally went to see a doctor, and she immediately thought of ankylosing spondylitis. She did a variety of movement tests (I laid down, she lifted my legs up, etc.) and told me that she thought the pain was mechanical and not inflammatory. She gave me some back exercises and stretches to do, and those definitely help the pain. She also said that I have extremely tight hamstrings, so I'm doing hamstring stretches as well. I should also mention that my father was diagnosed with osteoarthritis in his 30s and now has severe degenerative disc disease in his lower back. And I have no family history of autoimmune disorders. If it's relevent, I did experience IBS all throughout my last pregnancy, which was 3 years ago. The IBS went away after I had my second child and has not returned. I did pull a muscle in my upper back two months ago after we moved to a new home and I had done some lifting and reaching while I was unpacking, but that has gone away. I have two young children (2 and 4 yrs) and with the 2-year-old, I am constantly picking her up and carrying around, lifting her into her high chair, lowering her into her crib, etc.

I should also mention that I finally took 440 mg of Aleve yesterday, and that helped the pain. I also took 220 mg before bedtime and woke up with significantly less pain and greater range of motion in my spine.

After reading about ankylosing spondylitis, I am now terrified that this is what I have, despite what the doctor says. My fear is that I may be in the very early stages of the disease and that the iritis and other bad symptoms are yet to come. What other conditions might present with lower back stiffness in the morning that responds well to movement and NSAIDs? I am supposed to return to my doctor after 4 weeks if the pain continues, and she would refer me to physical therapy. So far, the pain has not improved (with the exception of when I took the NSAIDs) and, if anything, is getting slowly worse. I'm so scared...just hoping that this might be something that's not degenerative and chronic.

Thank you.

Category: Family Physician-GP

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Hello,

Thank you for asking your query at DoctorSpring.

I have gone through your medical history and I understand your concern. I assume you have read about certain Ankylosing Spondylitis features like good response to NSAIDs, response to movements etc and hence the concern. But I would like to say your approach is exactly right and Ankylosis Spondylitis is only a diagnostic possibility that needs to be ruled out. There is no clear cut features suggesting AS.

1. Your symptoms pattern is common. Back pain with spasms and stiffness is a very common complaint. The most common reasons are muscle strains, disc bulges, local inflammation etc. in your age group.

2. Response to NSAIDs or movements or Physical therapy is NOT a specific sign of Ankylosis Spondylitis. (AS). Inface certain conditions like initial stages of bulged disc etc will have excellent response.

3. If the symptoms persists, of course AS needs to be investigated and ruled out. So following up with your Doctor is very important.

4. So as of now this is better approached with lower back pain under evaluation. There is NO reason to be overly concerned or worried about AS. Other than your age there is no specific and suggestive risk factor.

5. If the symptoms persists your Doctor will order for further tests, which might include ANA, HLAB27, MRI of Spine etc.

Hope this helps
Please feel free to ask followup questions.

Thank you


Patient replied :

Thank you very much for your response, Dr. Sebastian, and for addressing my concerns. That does make me feel much better! I think the internet can be a wonderful thing at times, but also can sometimes give you unnecessary anxiety (at least, I hope it's unnecessary in my case!).

One further question: in all of my readings on back pain, they talk about pain that either comes on gradually or pain that comes on suddenly. When I pulled a muscle in my upper back a few months ago, that pain came on very suddenly as I was in the act of reaching my right arm up high. I felt almost an immediate and incredibly painful stabbing sensation in my shoulder blade. However, the lower back pain I'm experiencing now started with just a little bit of morning stiffness and over the course of a few weeks worsened into greater pain. Would a doctor consider that to be gradual onset? Or is the span of a few weeks not considered gradual?

And one final question: if this is a temporary condition that is causing me pain, how long should I expect to feel the pain? Weeks? Months? It has been about 5 weeks now, and the morning pain and stiffness is only getting worse. I'm just wondering at what point I should pursue further testing.

Thank you again,
Alyson


Hello,

Symptoms analysis in Backpain is NOT useful in many cases. It might not give any clue regarding diagnosis in all cases. For example in a back pain of the disc prolapse the pain can be sudden (developing over few hours) or gradual. Same cause but different type of presentation.
Unless caused by a trauma (as in fall / accidents) most of the back pains we see in clinical practice are gradual in onset. The patient might be able to say which month it started, at best the week, but not the date of onset.
So in your case what we can conclude is that the pain is NOT due to trauma. Inflammatory cause is likely because of the morning stiffness. At this stage we can never know whether this is a temporary condition or not. If it is pain can last upto 6 months.
5 month pain definitely requires evaluation. So please do followup with Doctor. Blood test +/- MRI is the most logical next step. Do discuss your concerns with your Doctor.
And yes Internet can bring into unnecessary anxiety, unless you use it judiciously. It’s not the information is wrong or misleading, but it is very difficult to put things into individual perspective without the comprehensive knowledge about a condition.

Hope this helps
Please do feel free to ask for clarifications / questions
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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