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Have you been diagnosed with any previous medical conditions apart from the Ankylosing Spondylitis?
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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?
My brother has been diagnosed, and my sister is having tests ( she's covered in psoriasis, and some days she cannot walk).
Okay, do you have any morning stiffness in the lower back?
and pain in my achilles tendons that takes an hour or so to die down
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.
Tell me, have you had any x rays?
X rays of the lower back (lumbosacral spine)?
Okay and your doctor has dismissed you without an x ray?
Though my GP agreed that I do have lower back, and shoulder pain
Yes, he dismissed me
Okay, did he give you any medication for it?
On a scale of 1 - 10, 1 being no pain and 10 being severe excruciating pain, how would you rate your pain?
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
Okay, which joints primarily show the most severe symptoms? Knee, lower back, hip, small joints of the hand?
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.
Okay. Have you had an ESR test done (blood test0?
What is an ESR?
Erythrocyte Sedimentation Rate, it is more accurate in chronic inflammatory conditions than a CRP which is more of an acute inflammatory marker.
No, I haven't had that done.
It is a blood test, taken from the vein like the CRP and takes 15 minutes or less to get the results.
Okay. I feel that the symptoms have been under evaluated.
Will it rule out AS?
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.
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.
It is just a test that makes the suspicion stronger, however, it is not something that would rule out AS.
Yes, I understand that, it is just that my GP is so dismissive.
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).
An MRI scan of the lower spine is warranted.
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.
Do you think it would be worth suggesting an X ray? Or should I just ask for the ESR and referral to a rheumatologist?
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.
That depends on your relationship with your GP.
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.
But in earlier stages of AS, x rays might not yield significant findings, so that is why an MRI is better.
I think he believes it isn't AS because I haven't mentioned aches and pains before. But it's such an insidious process.
I have had pains since my late teens, but they have worsened during the past five years.
Most chronic inflammations are insidious in their onset.
Well, thank you for your advice.
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.
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Feel better soon and best wishes.
Yes, I will. Thanks a lot.