Ankylosing Spondylitis Most Misdiagnosed Arthritis

Understanding Ankylosing Spondylitis

Our post today is about arthritis of the back, specifically Ankylosing Spondylitis (AS). It is crucial to be aware of this condition because it is one of the most commonly missed types of arthritis.

A Real-Life Example

Just two days ago, a young man brought his mother to me for treatment of arthritis. The young man himself had difficulty walking and his back was completely stiff. Despite consulting many doctors, his condition had gone undiagnosed. He was a classic case of Ankylosing Spondylitis. There are numerous similar cases where typically young men, often very young, suffer from arthritis of the back but remain undiagnosed. Therefore, raising awareness about this condition is vital.

Who is at Risk?

This type of arthritis usually begins at a young age, often in the 20s. Ankylosing Spondylitis is more common in men than in women. If there is a family history of arthritis, the risk of developing arthritis in the back increases. A specific gene, HLA-B27, is often associated with this condition. Various infections, especially intestinal infections and urinary tract infections, as well as conditions like psoriasis, can increase the risk of developing this disease.

Symptoms to Watch For

Typically, patients experience pain and stiffness in the lower back. This pain and stiffness are most severe after periods of rest, such as in the morning upon waking, and gradually improve with movement. Besides the lower back, the joints of the shoulders and hips are often affected. Additionally, other joints such as those in the feet, ankles, shoulders, knees, and hands may also be involved.

Progression and Complications

In the early stages, the primary symptom is lower back pain. As the disease progresses, movement in the lower back becomes increasingly restricted, and in very advanced cases, the spine may become completely rigid, a condition known as "bamboo spine," where there is no flexibility or movement in the lower back. Along with this, symptoms such as fatigue, weight loss, and general weakness are common. In some patients, there may also be swelling or redness in the eyes.

Importance of Early Diagnosis

The most important thing to note is that if you have persistent lower back pain that has not been diagnosed and has been ongoing for a long time, please consult a rheumatologist. This disease can often be diagnosed quickly based on history and physical examination. The HLA-B27 gene may be positive in affected individuals, but there is no specific blood test to diagnose this disease, which is why it is often misdiagnosed. X-rays may appear normal in the early stages, and by the time changes are visible on X-rays, the disease has usually progressed significantly. However, an MRI of the sacroiliac joints, which are important joints in the lower back, can help detect this disease early. Therefore, if you know any young person with ongoing pain and stiffness in the lower back, especially if it is worse in the morning, please encourage them to seek medical advice.