Diagnosis of ankylosing spondylitis
Diagnosis of ankylosing spondylitis is typically made by a general physician or rheumatologist, who considers symptoms such as back pain, stiffness in the back, pain with movement, and pain in other joints, including the knees and hips.
Ankylosing spondylitis is diagnosed through lab tests, radiographic imaging, and a review of prior medical and family history of the disease. Primary assessment is conducted through a physical examination and radiographic imaging by a physician or a rheumatologist. Laboratory biochemical tests are performed to confirm the diagnosis.
Medical History
Diagnosis of ankylosing spondylitis is often prompted by a medical history of chronic pain in the lower back. Characteristic medical history of ankylosing spondylitis may include:
- Chronic pain in the lower back for more than 3 months
- Decreasing mobility of the spine over time and pain with movement
- Back pain at night during sleep
The physician may ask about a family history of ankylosing spondylitis or other related diseases such as rheumatoid arthritis, about the location of the pain, and the effect of exercise/movement on the severity of pain.
Physical Examination
A physical examination is performed to assess the mobility of joints affected by ankylosing spondylitis. It may include:
- Pressing specific joints in the pelvis, spine, and chest to determine which joint is affected.
- Assessing the mobility of the spine in different directions
- Checking the joints of the knees, heels, and chest
- Monitor breathing to determine whether ankylosing spondylitis has progressed to the joints of the ribs.
- Checking for any deformity or changes in the posture.
Radiographic Imaging
Radiographic imaging of joints is used to diagnose the progression of ankylosing spondylitis, assess the morphology of the joints, evaluate bone density, and detect changes around the joints. It includes X-rays and magnetic resonance imaging (MRI).
MRI is a powerful imaging technique that can detect minute changes in the joints. It is an effective method for diagnosing ankylosing spondylitis at its early stages. It can detect inflammation in the joints and provides high-resolution images with detailed information about joints, ligaments, and surrounding tissue.
Imaging by X-rays is less sensitive than MRI, but it provides a general overview of the disease condition and any deformity in the spine. It is typically used to monitor disease progression in affected joints.
Laboratory Tests
Laboratory tests include genetic testing for HLA-B27. The allele for this gene is associated with ankylosing spondylitis in the majority of patients. However, some patients diagnosed positive for HLA-B27 may not show symptoms of ankylosing spondylitis.
Another biochemical laboratory test for ankylosing spondylitis is the C-reactive protein (CRP) test. This test is used to assess joint inflammation, disease progression, and monitor the response of ankylosing spondylitis to medication. The doctor may also suggest various biochemical tests to monitor the health of different organs, such as the liver, electrolytes, and calcium levels.
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