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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 8483
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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Hello, i'm a 44-year-old female, and suspect that i may have

Resolved Question:

Hello, i'm a 44-year-old female, and suspect that i may have ankylosing spondylitis. There is a history of it among my siblings, one of whom has recently tested positive for the HLA B27 gene.
My lower back and hips are constantly in pain. I wake up feeling as though my chest has been crushed, and I am always fatigued. I also have pain in my achilles tendons that causes my ankles to swell. I also have psoriasis.
My doctor recently took bloods to test for:
C-reactive protein
Rheumatoid factor
HLA B27 Gene
All came back negative. My GP didn't even want to see me because of the results.
My question is what can I do next? Are these tests final, or could I have AS? How do I get my GP to take me seriously? I am two thirds of the way through a history degree, hoping to take a masters next year, but the pain and fatigue is ruining my life.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr Uzair replied 3 years ago.
Dr Uzair :

Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Dr Uzair :

Have you been diagnosed with any previous medical conditions apart from the Ankylosing Spondylitis?

Dr Uzair :

Please enter chat and use reply to respond.

Customer:

None

Dr Uzair :

Alright, is there a history of diagnosed Ankylosing Spondylitis among your siblings or just is it just the HLA B 27 that was found positive?

Customer:

My brother has been diagnosed, and my sister is having tests ( she's covered in psoriasis, and some days she cannot walk).

Dr Uzair :

Okay, do you have any morning stiffness in the lower back?

Customer:

yes

Customer:

and pain in my achilles tendons that takes an hour or so to die down

Dr Uzair :

Okay, a strong and positive family history along with symptoms of back pain are enough to warrant a thorough examination and investigations to rule out AS.

Dr Uzair :

Tell me, have you had any x rays?

Customer:

none

Dr Uzair :

X rays of the lower back (lumbosacral spine)?

Customer:

No, none

Dr Uzair :

Okay and your doctor has dismissed you without an x ray?

Customer:

Though my GP agreed that I do have lower back, and shoulder pain

Customer:

Yes, he dismissed me

Dr Uzair :

Okay, did he give you any medication for it?

Customer:

No

Dr Uzair :

On a scale of 1 - 10, 1 being no pain and 10 being severe excruciating pain, how would you rate your pain?

Customer:

It varies, some days it is relatively mild - say when exercising - but on other days all of my joints ache to seven on the pain scale

Dr Uzair :

Okay, which joints primarily show the most severe symptoms? Knee, lower back, hip, small joints of the hand?

Customer:

My lower back, behind my ankles, and my hip, as well as my sternum - the centre of my chest has actually felt as though it has cracked into place. My right shoulder also aches.

Dr Uzair :

Okay. Have you had an ESR test done (blood test0?

Customer:

What is an ESR?

Dr Uzair :

Erythrocyte Sedimentation Rate, it is more accurate in chronic inflammatory conditions than a CRP which is more of an acute inflammatory marker.

Customer:

No, I haven't had that done.

Dr Uzair :

It is a blood test, taken from the vein like the CRP and takes 15 minutes or less to get the results.

Dr Uzair :

Okay. I feel that the symptoms have been under evaluated.

Customer:

Will it rule out AS?

Dr Uzair :

No, it will not, it is not a specific or definitive tests, there are none. The only way to confirm if a patient has AS is to correlate the labs with physical findings and those on the MRI scan of the spine or in late cases x rays also show significant findings.

Dr Uzair :

You see, most of the patients (95%) who have ankylosing spondylitis also test positive for HLA B27 but that does not mean the remaining 5 percent who are negative for HLAB27 do not have AS. And all patients with HLA B27 also do not have AS.

Dr Uzair :

It is just a test that makes the suspicion stronger, however, it is not something that would rule out AS.

Customer:

Yes, I understand that, it is just that my GP is so dismissive.

Dr Uzair :

I would suggest that you get an ESR done and ask your doctor to refer you to a Rheumatologist (doctors who specialize in treating rheumatologic conditions like AS).

Dr Uzair :

An MRI scan of the lower spine is warranted.

Dr Uzair :

If this is AS, then the earlier it is diagnosed and the sooner the treatment is started, the better the chances are to halt the disease where it is.

Customer:

Do you think it would be worth suggesting an X ray? Or should I just ask for the ESR and referral to a rheumatologist?

Dr Uzair :

Your strong family history and symptoms should alert any physician of the possibility of this being AS and a referral to a Rheumatologist will be the best course of action and a starting point.

Dr Uzair :

That depends on your relationship with your GP.

Dr Uzair :

You can get x ray and ESR done, they are not very expensive tests and they do not take a long time to get done.

Dr Uzair :

But in earlier stages of AS, x rays might not yield significant findings, so that is why an MRI is better.

Customer:

I think he believes it isn't AS because I haven't mentioned aches and pains before. But it's such an insidious process.

Customer:

I have had pains since my late teens, but they have worsened during the past five years.

Dr Uzair :

Most chronic inflammations are insidious in their onset.

Customer:

Well, thank you for your advice.

Dr Uzair :

There is no objective measurement of pain, no test for pain and no way to see pain, a physician has to believe a patient when a patient tells him/her that s/he is in pain and if the patient does not mention pain, then there is no pain.

Dr Uzair :

It has been a pleasure.

Dr Uzair :

Please do leave a positive rating for the service.

Dr Uzair :

Feel better soon and best wishes.

Customer:

Yes, I will. Thanks a lot.

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