AS describes exactly the pain I have
oh boy okay as iâve mentioned iâve got an extensive document on AS symptoms & mythbusting coming soon but iâve been wanting to do a quick summary of âwtf is that?â for a while and this is the perfect opportunity! most stats in this post from this 2022 summary article (link) but note that their gender stats are questionable as recent studies show equal prevalence regardless of âsexâ. so!
ankylosing spondylitis is a systemic autoimmune disorder characterized by inflammatory back pain. itâs estimated to be 1.5 times as common as rheumatoid arthritis and over 6 times as common as lupus (SLE) but is incredibly underdiagnosed, which is why iâm super loud about it!
key symptoms of inflammatory back pain:
most frequent onset in early 20s but can be juvenile or later. articles say onset is prior to age 40 but seeing as iâm deeply skeptical of all things medical establishment i wouldnât rule later onset out
either no history of mechanical trauma or unrelated (for example, i have a herniated disk but had AS symptoms for years before then)
pain gets worse with rest and better with movement - most sources say âexerciseâ but in the experience of me and other folks with AS iâve talked to thatâs debatable at best. my pain gets worse after remaining in the same position and better with rotating, stretching, etc; sitting upright is most painful for me, but on typical days i need to alternate laying down and standing / walking briefly
morning stiffness and back pain that wakes you up at night
alternating buttock (butt) pain
articles say inflammatory back pain improves with NSAIDs but iâve never met any chronically ill person whose pain has been made manageable with NSAIDs
AS can also include (usually asymmetrical) joint pain in other locations (especially large joints like the hips, shoulders, neck, and knees - juvenile AS commonly starts with pain in one or both knees prior to spine involvement), fatigue, peripheral neuropathy, and enthesitis (inflammation of tendon insertion points, especially plantar fasciitis).
CRP and ESR for inflammation. 40-50% of people with AS do not have elevated inflammatory blood markers.
HLA-B27 gene marker. less common in people with non-radiographic AS (doesnât show up on an x-ray) and more common in white people. only 6-10% of people who are HLA-B27 positive develop AS and plenty (10-30%) of people with AS are negative for HLA-B27 - myself included!
x-ray and MRI for spine inflammation. both of mine were negative; the absence of clinically visible inflammation does not rule out AS. there is a growing body of literature and education about non-radiographic AS; my rheumatologist put me on 20mg prednisone for a week while waiting on my bloodwork and scan results and when that helped my back pain immensely, said âyep itâs definitely inflammatory thenâ and that this is the standard of diagnosis/care rheumatological associations are advocating for
i wish you the absolute best of luck in finding an explanation and treatment for your pain đ if you (or anyone reading this who suspects they have AS!) have any questions feel free to reply, send me an ask, or dm me!