What is the ESR level in ankylosing spondylitis?

Written by Yang Ya Meng
Rheumatology
Updated on January 16, 2025
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Patients with ankylosing spondylitis, if not well controlled, can exhibit elevated erythrocyte sedimentation rates (ESR). An ESR higher than 20 mm per hour indicates elevation, suggesting poor disease control. At such times, it is necessary to utilize non-steroidal anti-inflammatory drugs (NSAIDs) such as sustained-release diclofenac sodium tablets. Additionally, medications that control the condition should also be used, like sulfasalazine tablets and thalidomide, among others. While biological agents, commonly tumor necrosis factor (TNF) antagonists, offer the best treatment effectiveness, they are also the most expensive. (The use of medications should be conducted under the guidance of a physician.)

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Written by Li Jing
Rheumatology
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Ankylosing Spondylitis Diagnosis Methods

Ankylosing spondylitis is primarily characterized by involvement of the elbow joints, but it can also be accompanied by extra-articular manifestations such as iritis and pain in the heel, and severe cases may present with spinal stiffness and deformity. The cause of the disease is unclear, but studies suggest it is related to genetic and environmental factors, with a significant familial aggregation. Diagnosis requires a combination of clinical symptoms, blood tests including HLA-B27, and imaging such as CT or MRI of the sacroiliac joints to confirm inflammation or damage to these joints. To diagnose ankylosing spondylitis, these three criteria must be met. The most important factor is the presence of clinical symptoms that persist for more than three months, improve with activity, and do not significantly improve with rest. This is a typical characteristic of ankylosing spondylitis.

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How is ankylosing spondylitis diagnosed?

Ankylosing spondylitis is an autoimmune disease that cannot be cured but can be managed primarily through medication. Its main typical symptoms include stiffness in the neck or pain in the lower back, with the pain becoming more apparent when at rest or after sitting for a long time. Symptoms tend to improve with movement. A typical occurrence is pain that awakens the patient at night. Peripheral joints like the knee joint and heel can also be affected. However, the main symptoms are stiffness in the neck and pain in the lower back. Diagnosing ankylosing spondylitis requires combining symptoms with a positive B27 blood test result, and imaging tests such as CT or MRI of the sacroiliac joints, showing signs of sacroiliitis, narrowing or damage in the sacroiliac joint space, to confirm the diagnosis.

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What to check for ankylosing spondylitis?

The examination for ankylosing spondylitis mainly includes blood tests. The main components of the blood tests are erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ANA along with CCP antibodies, and AKA antibodies, and of course, the most crucial test related to the gene - HLA-B27. Imaging exams can include the following: First, an X-ray of the pelvis, or an MRI of the sacroiliac joints. If the disease has been present for a longer time, a CT of the sacroiliac joints can be chosen. If the patient has elevated ESR and CRP, a positive B27, and lesions in the sacroiliac joints, then the diagnosis of ankylosing spondylitis can be confirmed.

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What to do about ankylosing spondylitis pain?

The methods for treating pain in ankylosing spondylitis primarily include non-steroidal anti-inflammatory drugs, such as sustained-release diclofenac sodium tablets; secondly, biologics can be considered for pain relief, but before using biologics, it is necessary to rigorously rule out diseases such as hepatitis, tuberculosis, and tumors. During the painful periods of ankylosing spondylitis, patients are advised to rest appropriately to alleviate joint inflammation. However, after the pain subsides, it is recommended that patients engage in functional exercises to prevent complications such as further adhesion and stiffening of the spinal joints. (Specific medications should be taken under the guidance of a physician.)

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Does ankylosing spondylitis have a genetic component?

Ankylosing spondylitis is an autoimmune disease primarily affecting the axial joints. The onset is determined by both genetic and environmental factors, leading to the disease. This means that the disease exhibits a significant familial aggregation and genetic predisposition. If the parents have it, the incidence in their children is much higher than in others. However, it is definitely not a genetic disease; it just has familial clustering and genetic tendencies. If symptoms like stiffness in the neck or pain in the lower back intensify when at rest and decrease after activity, it is essential to use CT or MRI scans and test for HLA-B27 to check for damage or narrowing in the sacroiliac joints. Early diagnosis and early treatment are crucial to improve the prognosis of the condition.