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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Remedy For Severe Lower Back Pain

My husband recently went to a rheumatologist upon recommendation of his orthopedic doctor. He is 34 and has had low low back pain for 2 years. His ortho performed an mri and couldnt find any issues. The radiologist suggested a slight bulge in his right SI/L5. After going to the rheumatologist, we have received a suggested diagnosis of Ankylosing Spondylitis, despite the fact that he is HLA-B27 negative with normal CRP and ESR. The rheumatologist stated that he did have narrowing of his SI joint (no issues with spine, hips, or knees xrays) and was basing his diagnosis on that. He wants to start my husband on TNF inhibitors. I am trying to get a second opinion, but it takes months to get into another rheumatologist as a new patient. If it truely is AS, I know that starting treatment early is the key... And I don t want to delay treatment that could prevent additional fusion. Could this just be arthritis in his SI joint, or does the narrowing definitely mean AS?
Thu, 27 Aug 2015
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General & Family Physician 's  Response
Thank you for contacting HCM with your health care concerns.

I am surprised that the rheumatologist jumped so quickly on the Dx of AS. If his sed rate CRP are all normal i see no basis for the diagnosis. Plenty of people have scarring of the SI joint and that does not mean they have AS. I would recommend a second opinion before starting TNF therapy because TNF therapy can have significant side effects.

I might suggest to you to go to a physical therapist and start a good exercise and stretching program to help with his pain. Also possibly a acupuncturist before I would commit to TNF

Good luck
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Suggest Remedy For Severe Lower Back Pain

Thank you for contacting HCM with your health care concerns. I am surprised that the rheumatologist jumped so quickly on the Dx of AS. If his sed rate CRP are all normal i see no basis for the diagnosis. Plenty of people have scarring of the SI joint and that does not mean they have AS. I would recommend a second opinion before starting TNF therapy because TNF therapy can have significant side effects. I might suggest to you to go to a physical therapist and start a good exercise and stretching program to help with his pain. Also possibly a acupuncturist before I would commit to TNF Good luck