Diagnosing Ankylosing Spondylitis
Because Ankylosing Spondylitis can involve so many different systems and parts of the body, it can be difficult for your doctor to monitor your disease. Different doctors use different methods to measure your disease activity and check your progress, including your medical history, blood tests and various types of imaging such as x-rays or MRI. When you have Ankylosing Spondylitis, your disease activity includes three key things: persistence of your symptoms, how likely you are to develop severe Ankylosing Spondylitis disease and damage or deformity of your bones, and your response to treatment.
Doctors may use the BASFI and BASDAI – two surveys that ask you about your symptoms such as overall fatigue, pain, joint swelling and stiffness, and how Ankylosing Spondylitis is affecting you and your daily activities. These surveys can help your doctor to determine whether you need a different or perhaps a more powerful drug.
There are signs of inflammation in your blood that your doctor can test. These test results can show how active your disease is and how well your treatments are working. These are often called inflammatory markers. You should know that not everyone’s markers correlate with their disease activity. You may be having pain and swelling while these markers look normal or vice versa:
- Erythrocyte sedimentation rate (ESR) or “sed rate”
- C-reactive protein or CRP
X-rays of the spine or sacroiliac joints can show how your Ankylosing Spondylitis is progressing and whether you have any joint damage. Magnetic Resonance Imaging (MRI) of the spine is gaining wider acceptance among doctors as an important tool to show your level of ongoing inflammation. Your doctor will determine which drug or drugs to prescribe based on the results of these tests, along with other factors including:
- Joint or organ damage
- Other diseases you have, such as liver or lung disease
- Possible reasons that the drug could do you harm and mean you should avoid it
- Your personal preferences, such as drugs that are taken as pills or injections
- Potential medication side effects
Side effects are changes that can occur in our bodies as the result of using a particular medication or device. Side effects can be mild or severe and can vary greatly from person to person.
Contraindications are situations when you should avoid taking a certain medication for health reasons. For example, you should not take DMARD therapy (a medication that is sometimes used to treat Ankylosing Spondylitis when non-steroidal anti-inflammatory medicines (NSAIDs) are not enough to control the pain, stiffness and inflammation) if:
- you are pregnant;
- have alcoholism;
- have alcoholic liver disease or other severe chronic liver disease;
- have immunodeficiency syndromes such as HIV/AIDS (some patients with HIV can take DMARDS and biologics under careful monitoring), in which your immune system is not working properly (overt or laboratory evidence);
- or have pre-existing blood dyscrasias (for example, bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia).
If you have active hepatitis A, B, or C, you will need to be treated for that by a liver specialist before you take any drugs for your Ankylosing Spondylitis that suppress your immune system or affect your liver. Your liver specialist and rheumatologist can both decide, if once your hepatitis is either stabilized or being treated, that you can start to take certain medications for your Ankylosing Spondylitis. But you’ll need to be monitored closely. You may need to come in for blood tests often.