A rheumatologist is a doctor who specializes in assessment and management of ankylosing spondylitis and other conditions affecting the integrity of the joints. The assessment involves ascertaining the physical condition of the patient, exploring his past medical record as well as family history and taking imaging tests in addition to blood tests. However, it should be noted that there lacks a direct procedure to detect the disease hence the need to combine various tests (Reveille, 2006).
Conditions that may be associated with ankylosing spondylitis include an age of thirty-five years or below, presence of chronic pain persisting for at least three months and inability to move the backbone at night and in the mornings due to spinal rigidity and agony. So, a patient who presents to the clinic with reduced ability to move the backbone may be suspected of ankylosing spondylitis. The level of spinal movement is studied through application of test like squatting and carrying out schober test as well as evaluating chest expansion rates. During the physical assessment, the rheumatologist examines the presence of inflammation on the patient’s body. As such, the physician tries to establish “pain and tenderness along the back, pelvic bones, sacroiliac joints, chest and heels” (Alpert, 2006).
A rheumatologist may also suspect the condition if the patient’s past medical records show occurrences of iritis or irritation of the eye previously. Other useful medical histories during the assessment of this disease include a record of gastrointestinal diseases such the Crohn’s Disease and ulcers of the colitis (Peh, 2004). An individual with relative(s) who suffer from ankylosing spondylitis may be suspected of the condition as well. Physical and medical history assessments are followed by imaging tests as well as blood tests.
Individuals suffering from ankylosing spondylitis have typical spinal changes and sacroilitis is evident. Sacroilitis is an inflammatory condition that affects sacroiliac joints that link the sacrum, ilium and the spine and such changes can be detected by use of x-ray tests. However, this method has a limitation in that sacroilitis may not be detected until ankylosing spondylitis is fully established and this may take seven to ten years. This may cause delayed treatment and possible complications. When physicians suspect the presence of the disease but it is not seen using x-rays, other tests like “magnetic resonance imaging (MRI) and computed tomography (CT scanning)” can be used since they are more responsive (Braun, Sieper & Bollow, 2000). However, the consistency of these tests is not well known. Schober’s test may also be used during the examination of joints.
There lacks a comprehensive blood test that can authoritatively confirm or rebuff the presence of ankylosing spondylitis. However, individuals undergoing some inflammatory conditions may have elevated levels of C-reactive protein as well as enhanced red blood cell sedimentation rate. Nonetheless, some patients suffering from inflammation have normal levels of C-reactive proteins as well as normal erythrocyte sedimentation rate and thus such tests are not specific to ankylosing spondylitis. Furthermore, less than seventy percent of individuals suffering from inflammation experience these changes (Reveille, 2006). Besides, ‘complete blood counts’ may be done to determine the amount of erythrocytes present in the body. Reduced amounts may signify the presence of the disease.
Blood test is also carried out to determine the presence of ‘Human Leukocyte Antigen (HLA) B27’ gene which is usually associated with the condition. However, this is not a definitive test as well. Individual who test negative for this gene are less likely to get the condition unlike the ones who have it. HLA-B27 is a normal genetic constituent of a human being and its correlation with ankylosing spondylitis differs among individuals of different backgrounds. According to Alpert (2006), this gene is strongly common in ankylosing spondylitis patients of Caucasian origin (95%) and those of Mediterranean region (80%). It has a fifty percent correlation rate among Americans of Africa origin. Two other genes, “ARTS1 and IL23R” have recently been discovered and their presence may be associated with ankylosing spondylitis (Reveille, 2006).
“Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)”, test has also been used to evaluate the level of inflammation as a result of ankylosing spondylitis (Peh, 2004). However, this is not used for initial diagnosis but rather for assessing patient’s response to treatment. It is performed along with other ankylosing spondylitis assessment tests.
References
Alpert, J. S. (2006). The AHA Clinical Cardiac Consult. United States: Lippincott Williams & Wilkins.
Braun, J., Sieper, J., & Bollow, M. (2000). Imaging of sacroiliitis. Clinical Rheumatology, 19(1), 51-57.
Peh, W. C. (2004). Cervical spine ankylosing spondylitis. American Journal of Orthopedics, 33(6) 310.
Reveille, J. D. (2006). Major histocompatibility genes and ankylosing spondylitis. Best Practice & Research Clinical Rheumatology, 20 (3), 601–609.