A rheumatologist will generally diagnose and treat nr-axSpA. Rheumatologists have special training in diagnosing and treating disorders that affect the joints, tendons, ligaments, connective tissue, muscles, and bones.
Unfortunately, there is no clear diagnostic test for nr-axSpA. This means that a thorough physical exam by a knowledgeable doctor, along with a detailed patient and family history, is truly key. Blood tests and imaging (x-ray or MRI) are also often helpful.
A physical exam entails looking for sites of inflammation. Your doctor will likely check for pain and tenderness along the back, pelvic bones, sacroiliac joints, neck, chest, and heels. During the exam, your doctor may also check for signs of psoriasis (a scaly skin rash), pain, stiffness, or swelling in peripheral joints, and limitations in spinal mobility.
Other symptoms and indicators are also considered, including a history of iritis or uveitis (painful inflammation of the eye), a history of gastrointestinal issues or conditions (Crohn’s disease and ulcerative colitis are both associated with nr-axSpA), as well as fatigue, which can be caused by inflammation in the body. This visit should include other things besides the exam itself, including a thorough discussion of symptoms, personal and family medical history, and, when appropriate, ordering of relevant blood work.
Often a rheumatologist will test the blood for the HLA-B27 gene marker, and for higher-than-normal inflammatory markers such as erythrocyte sedimentation rate (ESR), also known as SED rate, and C-reactive protein (CRP), which may indicate systemic inflammation. It is important to note that bloodwork is not always helpful, as not everyone with nr-axSpA will have the HLA-B27 gene marker, or always show elevated inflammatory markers.
Finally, there is no association between nr-axSpA and rheumatoid factor (associated with rheumatoid arthritis) or antinuclear antibodies (associated with lupus).
Imaging tests such as an x-ray or MRI can be powerful tools in discovering inflammation or damage in the spine. However, those with nr-axSpA will not have definitive damage to the SI joints visible on plain x-rays.
MRI of the SI joints can show evidence of inflammation not visible on x-rays. Therefore, MRI can be a very important tool in diagnosing nr-axSpA.
A rheumatologist can order the appropriate tests, conduct a thorough physician exam, and is best suited to determine the correct rheumatic diagnosis. If you do not already have a rheumatologist, SAA can help you find one near you at Spondylitis.org/Rheumatologist-Directory.
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