Difference between Axial Arthritis and Ankylosing Spondylitis?

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elcamino
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Date Joined Sep 2005
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   Posted 3/13/2006 7:10 AM (GMT -7)   
I understand that with IBD, which is a potential diagnosis for me, that you can have either axial arthritis of the spine, or peripheral arthritis of the hands and feet.  The joints that are involved with me are my hips, shoulders, neck, knees, ankles, hands, and sometimes feet, including the heels.  The most consistently painful joints are the hips and shoulders and neck.  To me, that sounds like axial arthritis, not peripheral.  When you read about axial arthritis, you find a lot of stuff out there on Ankylosing Spondylitis (AS).  From what I've read, however, AS much more common in males, but it does often develop in concert with IBD.  One source I read stated that females can get it, but it's manifested in different ways.  With a male, the most common and painful symptom is lower back pain.  With females, symptoms often arise in the hips, shoulders, and neck.  Do I have AS?  And what is the difference between axial arthritis and AS, or are they one and the same?
 
Also, what is more puzzling is that AS is typically a sero-negative arthritide, meaning you normally don't have a positive rheumatoid factor.  I have always had consistently positive RF, albeit a low positive RF.  Does this eliminate AS?  Can you have a positive RF and have IBD? 
 
Elcamino

Ides
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Date Joined Nov 2003
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   Posted 3/13/2006 3:25 PM (GMT -7)   
Elcamino, hope you don't mind me waying in on this. I was first diagnosed with the typical peripheral arthritis associated with Crohn's Disease and Ulcerative Colitis. My rheumy wrote spondyloarthropathy with enthesitis and said this was the arthritis associated with IBD. He knew at this time that I was HLA B27 positive. While being HLA B27 positive with symptoms does not always mean AS, it usually does. My peripheral involvement continued to worsen. It was the Achilles tendon inflammation and plantar fasciitis, and the calcification of the shoulder tendons and then the Achilles, that changed the situation. Additionally, once the CD was in remission, the arthritis continued to flare. AS runs a course independent of the IBD. The arthritis associated with IBD waxes and wanes with the course of the inflammatory bowel disease activity. I now have the Ankylosing Spondylitis diagnosis.

The Spondylitis Association of America site has a message board. One of the frequent discussions is the difficulty women have getting diagnosed because so many believe AS to be a "man's disease." And you are correct - women can present differently with this disease.

The fact that you have a low RF could be meaningful. I have read of others that have false positive RFs and their RF is always low. I am not well versed in RA so will let others answer those questions.

Have you had an MRI of the SI joints or the cervical area? Have you had a HLA B27 test?
CD, Ankylosing Spondylitis, connective tissue disease,
asthma, PAD, peripheral neuropathy
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elcamino
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   Posted 3/13/2006 5:20 PM (GMT -7)   

Hi Ides, your information and opinions are always welcome!  I have not had an MRI of anything yet; nor have I been tested for HLA-B27.  Rheumatologist feels I have the enteropathic arthritis.  If my colitis goes into remission, the arthritis should resolve itself.  Interestingly, however, my colonoscopy of a few weeks ago showed a clean colon, no inflammation or ulcers.  I also have very few lower GI symptoms right now.  My arthritis continues to worsen, and at the very least, is persistent from one day to the next.  I intend on discussing this with my rheumatologist when I see him in a few weeks. 

I discussed the low positive RF with him.  He says it is meaningful because of my joint pains and because of my age--I'm only 38.  The only false positives he's aware of are with just a few older people (age 65+).  I know that a low positive RF is implicated in other things besides RA (which I'm fairly sure I don't have)--SLE, Scleroderma, mixed connective tissue disease.  It hasn't been lost on me that my mother also had a low positive RF and was eventually diagnosed with mixed connective tissue disease.  But it took years of joint pains before she developed any other symptoms.

I was simply wondering if RF is implicated in IBD, although most IBD-related arthritis is sero-negative?

Elcamino


Ides
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Date Joined Nov 2003
Total Posts : 7077
   Posted 3/13/2006 5:34 PM (GMT -7)   
Elcamono, if your gut is not showing signs of inflammation, and your arthritis is worsening, then I say it is not enteropathic arthritis. That's when my GI and rheumy knew something was up with me because the arthritis continued to flare after my CD was in remission.

If your heels are bothering you, I strongly urge you to make them check those out. It you have enthesitis of the Achilles or plantar fascitis, then you likely have AS. My rheumy uses ultrasound imaging to look at the tendons and bursa. I haven't asked if he can check the plantar fascia using that. Try to get the rheumy to order either ultrasound imaging or MRI of one of those problem areas.

Another thought too - if you are having increased joint pain, have they considered drug induced lupus? I got very severe joint pain from that. All of the biologics can cause it. In fact I am now diagnosed as having diffuse connective tissue disease.
CD, Ankylosing Spondylitis, connective tissue disease,
asthma, PAD, peripheral neuropathy
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curley
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Date Joined Mar 2005
Total Posts : 4305
   Posted 3/13/2006 5:47 PM (GMT -7)   
Hi,I know that Arthritis can be hard to understand.But Ides has gave you some really good advice.I tested positive for HLA-B27 and I do have ANKYLOSIBNG SPONDYLITIS as well.This effect's my lower back and upper sholder's.I as well have OA,RA,CROHN'S AND SJERENSE.
Thanks
Curley......
a.k.a.Mela...........


starrnr
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Date Joined Dec 2005
Total Posts : 1782
   Posted 3/13/2006 10:24 PM (GMT -7)   
Hi. I hope you don't mind me popping in.

I have RA & AS and I'm a woman. I am sero-negative for the RF and I am HLA-B27 positive. Both the RA & AS were confirmed via x-rays, my sed rates have always been well within the normal ranges even in the midst of my worst flares. I'm currently being tested for IBD (I do have IBS). While it is true that women may present with different symptoms, we still get AS. It is no longer a 'man's' disease! The major issue with women being diagnosed with AS is that we typically don't show the same rate of fusing as the men. For some reason (hormones seem to be the theory), a lot of women can take years to fuse, while men can literally fuse in a few years. I was diagnosed over 10 years ago with RA relatively quickly. I was just diagnosed with AS 2 years ago and I presented with symptoms at least 10 years before my first symptoms of RA -- they just couldn't 'see' anything.

My AS is in my SI joints, neck and feet...my rheumy recently asked how my heels were (I always complain about them) -- they could see the soft tissue inflammation in my latest x-rays. How they could see that is beyond me!

BTW, you can be B27 negative and have AS. Good luck...our biggest issue is the diagnosis -- once that seems to be settled, getting the right med's seems to be a breeze (in a manner of speaking). Sorry for being long winded.

Sherree

elcamino
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Date Joined Sep 2005
Total Posts : 1744
   Posted 3/14/2006 5:26 AM (GMT -7)   

Thanks everyone for your input.  Again, I haven't been tested for HLA B27 yet, but I'm not sure it's really necessary.  I'm starting Enbrel today and that is used for RA as well as AS.  I think the more important distinction is between AS and Enteropathic arthritis.  If I have AS, then there's a chance I don't have IBD (even though I know that AS often goes along with IBD, it can exist independently).  If I have enteropathic arthritis, then I most likely do have IBD. 

I figure if I do have IBD, then the colitis is definitely secondary to the arthritis, which my GI doctor and rheumatologist claim is possible.

Elcamino


Ducky
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Date Joined Mar 2005
Total Posts : 3199
   Posted 3/14/2006 1:19 PM (GMT -7)   
I'm kinda in the spot you're in I have PA and some of they symptoms of PA are the same as AS. But I was HLA B27 negative. However, my rheumy said, that doesn't necessarily mean I don't have AS. He says, that there are other tests and stuff out that that could help pinpoint it better. He just wants to keep an eye on me and see if it progresses any. I know since I've been on Enbrel,my back really hasn't bothered me much. So I guess what I'm trying to say to you is, I think you are on the right track with your frame of mind. When do you go back in to see the doc? See if they can test you for HLA B27 and do an MRI. How did your Enbrel injection go? You should notice a significant change in your back in a couple of weeks or so with the Enbrel, I know I did... good luck to you and let us know how you're doing! Duck
Diagnosed January 2005 - Psoriatic Arthritis/Spondylitis
-Currently taking 50mg shot weekly of Enbrel
Diagnosed May 1998 - Graves Disease
-Complete Thyroidectomy September 1998 - While 11 weeks pregnant
Other Complications - GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes
Current Meds -  Enbrel/Prevacid/Synthroid
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots

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