Diagnosing ankylosing spondylitis usually involves multiple tests. When doctors order blood tests to diagnose ankylosing spondylitis, an individual is experiencing worsening symptoms in their back and joints. Often, a blood test diagnosis means the doctor is looking for evidence of anything else that could be causing the symptoms. However, blood tests by themselves cannot definitively diagnose ankylosing spondylitis, but when combined with imaging and assessment, they can provide important clues that point to the answers.
Ankylosing Spondylitis Blood Test Diagnosis
Ankylosing spondylitis is arthritis that primarily affects the spine and hips. It can be difficult to diagnose as no single test can provide thorough information for a definitive diagnosis. A combination of diagnostic tests are utilized, including a physical exam, imaging, and blood tests. Doctors are not only looking for results that will point to ankylosing spondylitis, but they are looking for any results that might point away from the spondylitis results that might provide a different explanation for symptoms.
Physical Exam
The diagnostic process will begin with the individual’s medical history, family history, and physical exam. During the exam, the doctor will ask questions to help rule out other conditions:
How long have symptoms been presenting?
Do symptoms get better with rest or exercise?
Are the symptoms getting worse or staying the same?
Are the symptoms worse at a particular time of day?
The doctor will check for limitations in mobility and palpate tender areas. Many conditions can cause similar symptoms, so the doctor will check to see if the pain or lack of mobility is consistent with ankylosing spondylitis. The feature sign of ankylosing spondylitis is pain and stiffness in the sacroiliac joints. The sacroiliac joints are located in the lower back, where the base of the spine and pelvis meet. The doctor will look at other spinal conditions and symptoms:
Back pain symptoms caused by – injuries, posture patterns, and/or sleeping positions.
The HLA-B27 gene corresponds with ankylosing spondylitis; if an individual has it, one of their parents has it.
Imaging
X-rays often serve as the first step to a diagnosis.
As the disease progresses, new small bones form between the vertebrae, eventually fusing them.
X-rays work best at mapping the disease progression than the initial diagnosis.
An MRI provides clearer images in the early stages as smaller details are visible.
Blood Tests
Blood tests can help rule out other conditions and check for signs of inflammation, providing supportive evidence along with the results of imaging tests. It typically only takes about a day or two to get the results. The doctor may order one of the following blood tests:
Antinuclear antibodies, or ANA, go after the proteins in the cell’s nucleus, telling the body its cells are the enemy.
This activates an immune response that the body fights to eliminate.
A study determined that ANA is found in 19% of individuals suffering from ankylosing spondylitis and is higher in women than men.
Combined with other tests, the presence of ANA provides another clue to a diagnosis.
Gut Health
The gut microbiome plays an important role in triggering the development of ankylosing spondylitis and its treatment.
Tests to determine the gut’s health can give a doctor a complete picture of what is happening inside the body.
Blood test diagnoses for ankylosing spondylitis and other inflammatory conditions rely heavily on piecing together different tests alongside clinical exams and imaging.
Causes, Symptoms, Diagnosis, and Treatment
References
Cardoneanu, Anca, et al. “Characteristics of the intestinal microbiome in ankylosing spondylitis.” Experimental and therapeutic medicine vol. 22,1 (2021): 676. doi:10.3892/etm.2021.10108
Prohaska, E et al. “Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew)” [Antinuclear antibodies in ankylosing spondylitis (author’s transl)]. Wiener klinische Wochenschrift vol. 92,24 (1980): 876-9.
Sheehan, Nicholas J. “The ramifications of HLA-B27.” Journal of the Royal Society of Medicine vol. 97,1 (2004): 10-4. doi:10.1177/014107680409700102
Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK470173/
Xu, Yong-Yue, et al. “Role of the gut microbiome in ankylosing spondylitis: an analysis of studies in the literature.” Discovery medicine vol. 22,123 (2016): 361-370.
Spinal nerves send motor, sensory, and autonomic signals between the central nervous system and the body and are part of the peripheral nervous system. They are essential for carrying information that controls body movements and sensations to the brain. When a nerve gets injured, compressed, or damaged, it can cause discomfort, increased sensitivity, numbness, muscle weakness, and pain.
Damaged Nerve Roots
Nerve root pain is often caused by other underlying conditions that have caused compression or damage to the nerve root. Causes of nerve root pain can include:
Spinal nerves impacted by injuries or infection can lose their ability to control the body areas, lose their functional capacity, lose sensation, and die.
Spinal Imaging
Nerve damage can be diagnosed on a neurological exam and correlated with MRI and X-ray imaging. Conditions that MRI can identify include herniated discs, spinal cord compression or fracture, arthritic development, tumors, or cysts pressing on a nerve.
MRI images are obtained with a magnetic field and radio waves.
MRI shows spine images from the side/sagittal view and cross-sectional/axial views.
This allows the chiropractic doctor to see the vertebrae and discs and identify abnormalities.
The spinal cord is a gray area in the middle surrounded by the spinal fluid, which appears white.
Little white channels on either side of the spinal cord are where the nerve roots branch off.
X-rays can show the alignment of the bones along the spine and determine any narrowing or damage to the discs.
It is important to be evaluated and diagnosed for signs and symptoms of nerve injury as soon as possible, as nerve damage accelerates and worsens.
Function Restoration
Sometimes, the symptoms improve by themselves and do not require treatment. Nonetheless, physicians begin with conservative, non-surgical approaches to treat nerve root pain. Chiropractic and physical massage therapy involves specific movements, stretches, and exercises to keep the affected muscles and joints active,prevent stiffness and help restore function and feeling. Treatment can include:
Therapeutic massage
Manual adjustment/resistance treatment
Trigger point therapy
Instrument-assisted soft tissue therapy
Decompression
Traction
Joint stretching
Electrical stimulation
Ultrasound
Specialized exercise
Activity modification
Anti-inflammatory diet
Nerve Chiropractor
References
Liu, Yan, and Huan Wang. “Peripheral nerve injury-induced changes in the spinal cord and strategies to counteract/enhance the changes to promote nerve regeneration.” Neural regeneration research vol. 15,2 (2020): 189-198. doi:10.4103/1673-5374.265540
Menorca, Ron M G, et al. “Nerve physiology: mechanisms of injury and recovery.” Hand clinics vol. 29,3 (2013): 317-30. doi:10.1016/j.hcl.2013.04.002
Shehab, Safa Al-Deen Saudi. “Fifth lumbar spinal nerve injury causes neurochemical changes in corresponding and adjacent spinal segments: a possible mechanism underlying neuropathic pain.” Journal of chemical neuroanatomy vol. 55 (2014): 38-50. doi:10.1016/j.jchemneu.2013.12.002
Stoll, G, and H W Müller. “Nerve injury, axonal degeneration, and neural regeneration: basic insights.” Brain pathology (Zurich, Switzerland) vol. 9,2 (1999): 313-25. doi:10.1111/j.1750-3639.1999.tb00229.x
Ye, Xuan, et al. “Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury.” Journal of neurosurgery. Spine vol. 28,5 (2018): 555-561. doi:10.3171/2017.8.SPINE17582
Multiple sclerosis and sciatica can exist side by side or have overlapping symptoms. The sciatic nerve begins at the lower back, then through the hips into the buttocks, and separates into both legs into the feet. Sciatica is a type of pain caused by a compressed/pinched or damaged/injured sciatic nerve. The sensation radiates across the nerve with frequency and severity at varying levels, depending on the individual’s body position and/or movement. Individuals with multiple sclerosis can also experience sciatica, believing it’s their multiple sclerosis. Neuropathic pain is a common symptom in multiple sclerosis or MS. It is caused by injury or damage to the nerves of the central nervous system and can cause burning, or sharp, stabbing sensations.
Multiple Sclerosis and Sciatic Nerve Pain Difference
MS is an autoimmune disorder where the immune system attacks the protective layer around nerve fibers known as myelin. This affects the central nervous system pathways that regulate feeling and sensation in the body. It can cause painful sensations that include:
Muscle spasms
Burning, tingling, or aching in the lower legs
Electrical shock-like sensations travel from the back toward the legs.
Migraines
The painful sensations result from the damaged nerve fibers creating interference in the brain’s neural pathways.
Sciatica works differently
An autoimmune response does not damage the sciatic nerve’s pathway, but an added stress/pressure compresses the sciatic nerve. The pain is usually caused by a quick, jerking, twisting, bending, reaching motion that pinches or twists the nerve. Herniated discs and bone spurs are another common cause, along with being overweight can place intense pressure on the sciatic nerve. The critical difference is that multiple sclerosis causes the central nervous system’s signaling pathways to malfunction.
MS and Sciatica
Most individuals, around 40%, will at some point experience some form of sciatica symptoms. This is from age, and all the wear and tear the low back goes through daily. This is why it’s not unusual for individuals with MS to experience sciatica as well. MS can cause body changes that affect activity levels.
Decreased mobility can lead to sitting for extended periods that can strain the muscles, tendons, and ligaments, causing sciatica.
There is evidence that the lesions that present from MS can extend to the sciatic nerve.
One study compared 36 individuals with MS to 35 individuals that don’t have it.
The research found that those with MS had slightly more lesions on the sciatic nerve than those without MS.
Sciatica Care
It can be challenging to figure out the types of pain being experienced. Sciatica travels down the length of the nerve uniquely and is often felt in only one leg. The pain, tingling, numbness, electrical sensations can present only in the lower back, the buttock, the back of the leg, hamstring, calf, and foot, or in a combination of all the areas. Treatments for sciatica depend on the severity. They include:
Medications – anti-inflammatories, muscle relaxants, tricyclic antidepressants, and antiseizure medications.
Steroid injections – corticosteroids
Surgery is a last resort reserved for severe cases that did not improve with other treatments and therapies.
It can be easy to mistake sciatica as a symptom or related condition of multiple sclerosis. Chiropractic can help alleviate sciatica, and although treatment cannot directly treat MS or its symptoms, it can relieve pain and discomfort.
Body Composition
Diabetic Nephropathy
Diabetic nephropathy or diabetic kidney disease is the result of mismanaged diabetes. Kidney failure is a severe medical emergency and can be fatal if not treated. Chronic low kidney function results in:
Fluid retention in the body.
Inability to filter out metabolites and waste from the blood.
Increased risk of infections.
Common symptoms of diabetic kidney disease include:
Increased blood pressure
This is the result of increased stress on the body.
The kidneys can no longer filter out all the metabolites and excess fluid needed to stabilize the blood pressure.
Chronic kidney damage results in the protein being excreted through urine.
Fatigue
Poor kidney function affects every organ in the body.
The organs have to work harder to compensate, leading to fatigue and low energy.
Lower extremity edema
Fluid retention usually presents in the lower extremities.
Puffy, swollen ankles and legs may appear shiny or waxy.
This is common in individuals that have severe diabetic nephropathy.
Shortness of breath
As the fluid builds up in the body, additional weight can get stored on and around the lungs.
This can make breathing very difficult when lying down or when engaged in physical activity.
Impaired cognition
Metabolites in the blood can cause brain damage when not filtered properly.
Memory loss
Mood changes
Loss of consciousness
References
Jende JME, et al. (2017). Peripheral nerve involvement in multiple sclerosis: Demonstration by magnetic resonance neurography. DOI:
10.1002/ana.25068
Mayo Clinic Staff. (2019). Sciatica.
mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
Murphy KL, et al. (2017). Chapter 4: Neuropathic pain in multiple sclerosis—current therapeutic intervention and future treatment perspectives.
ncbi.nlm.nih.gov/books/NBK470151/
Pain and itching. (n.d.).
nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain
Samson K. (2017). In the pipeline-multiple sclerosis neurography, MRI reveals peripheral nerve lesions in MS patients. DOI:
10.1097/01.NT.0000527861.27137.b0
Sciatica: Of all the nerves. (2016).
health.harvard.edu/pain/sciatica-of-all-the-nerve
With an intense automobile, work, sporting/fitness accidents, and natural disasters, individuals can experience multiple traumas, also known as polytrauma. Recovery and rehabilitation can be challenging journeys. Multiple traumas are serious medical emergencies only given to individuals going through difficult situations. Polytrauma references multiple severe traumas that occurred at the same time. An individual can experience a:
Physical therapy and chiropractic rehabilitation could be part of a treatment program. This is to restore the body’s mobility, function and promote the body’s natural healing abilities. The importance of creating the proper rehabilitation program can make all the difference, and restoring the integrity of the spine is critical.
Spinal Stabilization
Any trauma, despite its severity, can have the potential to interfere/disrupt spinal functions.
Suffering a concussive hit to the head could cause damage to the cervical spine.
Falling off a ladder could shift the vertebral discs.
Hitting the knee on an object can cause a spinal misalignment from shifting the weight to the other leg for a day or two.
Spinal misalignments and/or dysfunction are common in multiple trauma cases. Dealing with broken bones and substantial wounds often means the spine could need to be realigned even if there are no localized injuries to the back or neck. Spinal misalignment, translation/rotation, herniated discs, or other conditions can hinder the overall recovery process and present new health issues.
Nerve Damage
Often, a lasting issue from multiple traumas is nerve damage. The severity can destroy nerve endings, making it impossible to regain feeling or movement in certain areas of the body. The nerve damage can be regenerated if the impediment is rooted in the spine and is addressed in time.
Correcting spinal discs that have shifted along with subluxations that can compress the nerves and interfere with signal communication can help restore the areas directly affected. Example: Broken arms or legs can lose sensations that can be regained by spinal realignment. Some arteries follow the spinal pathway. Proper circulation/blood flow is achieved when the spinal integrity is restored, which is essential in natural recovery.
Trauma Beyond the Injury
Developing the correct rehabilitation treatment plan could mean the difference in a speedy and healthy recovery. Chiropractic can be an integral part of the recovery process, especially for a body that has sustained severe musculoskeletal injuries. The spine is an extension of the central nervous system. This means that bringing relief to the spine can affect positive healing in the injured areas. The critical role of the spine in an individual’s rehabilitation and whole well-being is why no matter the extent of the trauma, we deliver relief.
Auto Accident Injury Treatment
References
Kroupa, J. K definici polytraumatu a polytraumatismu [Definition of “polytrauma” and “polytraumatism”].Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca vol. 57,4 (1990): 347-60.
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