I had to learn to always have a “high level of suspicion” for Ankylosing Spondylitis (AS) while a rheumatologist-in-training. This meant, I needed to “unlearn” most of what I was taught about back pain as an internal medicine resident. As an internist or primary care provider, you see a lot of patients with back pain. It is very common. In order to keep costs down and not overly worry patients, doctors are trained to treat back pain with common anti-inflammatory medications before jumping to x-rays and MRIs. And this isn’t JUST to keep costs down. The overwhelming majority of those with back pain will have resolution of that pain within 2 months. Hence, doing an MRI on every patient just doesn’t make sense. But as a rheumatologist, we are trained to look at back pain differently.
The fact that most back pain will self-resolve is still true, but we are trained to have a more precise “nose” for inflammation. We ask the questions that get to the heart of inflammation and know what signs to look for aside from the back. Ankylosing Spondylitis is an autoimmune inflammatory arthritis that affects the back and it can take patients years to reach a diagnosis. Not wanting to be another doctor who missed the clues, I became obsessed with finding the sacroiliac inflammation typical of AS and prided myself on my physical exam and pointed questions during my appointments.
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