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One of the biggest issues of ankylosing spondylitis is how long it takes to be sure you’ve actually got it. The problem is that, in its early stages, ankylosing spondylitis symptoms can look like a range of less-serious issues. It’s all too easy to put that little bit of back pain down to yesterday’s heavy bag or last night’s awkward sleeping position.
There is no one test to confirm the presence of AS. Blood tests or an MRI scan can help your doctor get closer to a diagnosis but these are unlikely to be carried out during a routine health check. So how can you tell if those aches and pains could be more than they seem?
Dr Shashank Akerkar, Consultant Rheumatologist and regular This AS Life contributor, has created a video and shared some questions below for anyone worried that their back pain might be AS:1
Video created by Dr S Akerkar1
Do you suffer from back stiffness in the morning and/or back pain at night? 1,2
We’re all a little bit creaky when getting in or out of bed. However, if you’re still feeling stiff more than 30 mins after getting up or are being kept awake by
your back pain, both are warnings worth paying attention to.
Does your pain get better with exercise but not with rest? 1,2
AS pain comes from your joints stiffening up. With this in mind, although it’s very tempting to rest your aches, sitting still may just cause you to freeze up even more. It’s the reason that your backache will tend to be worse just after getting up but will settle down once you’ve been up and about for a bit.
If the key to relieving your pain isn’t putting your feet up but getting them moving again then it could be AS-related.
Do you experience buttock pain that shifts from side to side? 1,2
If you find yourself shifting around a lot when working or watching TV, don’t assume it’s the chair that’s uncomfortable. AS often causes inflammation in the sacro-iliac joints (the places where your legs attach to your pelvis) and this pain can be felt in the muscles around them.3
Are your joints often painful and/or visibly swollen? 1,2
Visible swelling in joints such as the knees and ankles may be one of the clearest early signs of AS. Similar swelling will be seen in the heel where tendons or ligaments attach to the skeleton. This is a condition known as enthesitis and is a key feature of AS.
Swelling may also affect entire fingers or toes, a feature known as dactylitis or ‘sausage digit’ (which should give you a pretty clear idea of what to look for).
Have you been diagnosed with any conditions associated with AS? 1,2
If you’re on the lookout for AS, you’ll probably be alert for back problems but there are other, seemingly-unrelated, conditions associated with an increased risk. These include:
uveitis (redness and inflammation of the iris, the colored part of the eye)
inflammatory bowel disorder (Crohn’s disease or ulcerative colitis)
Do you have a history of these related conditions in your family? 1,2
It’s not just the state of your health that could provide clues to the presence of AS. A family history of the condition itself is a clear sign but it’s also worth looking for related conditions in your family tree.
The associated conditions talked about in the previous question have genetic links to AS so, even if you don’t have them, the fact that your dad or your grandma – even your uncle - does could still point to an increased risk of AS.4
I think I may have AS – what’s my next step?
Facing the possibility of an AS diagnosis is obviously a scary prospect. However, the earlier you spot it, the earlier you can tackle it and the less power it’ll have over you. If you’re experiencing any of the symptoms we’ve talked about, take control early and speak to your doctor.
Once you’ve got an appointment set, there are a few things you can do to prepare, helping your doctor get to the root of the problem as quickly as possible:
Note down the precise symptoms you’re experiencing and how often you have them
Think about what times your pain is worst and what seems to relieve it
Have an in-depth look into your family history so you can give your doctor a comprehensive list of any AS-related conditions present in your nearest and dearest
To provide some guidance as to whether you might have ankylosing spondylitis, you can also visit one of the following sites:
Dr Shashank Akerkar is a Consultant Rheumatologist at the Mumbai Arthritis Clinic and Research Centre in India. Describing himself as a ‘patient-centric Rheumatologist’, Dr Akerkar regularly tweets and blogs on a range of rheumatology topics (including ankylosing spondylitis). He is also the creator of an app specifically for patients with lupus.
Take on AS with an army behind you. Patient support groups can be there to celebrate with you in the ups and pick you up in the downs. They’re also great places to get practical advice about living with AS.