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Disc injury, Ankylosing Spondilitis

BhargavJBBhargavJ Posts: 9
edited 03/04/2015 - 3:43 AM in Arthritis, Osteoarthritis
I'm 30 years old, male. I got injured in 1999; prolapsed intervertebral disc L 4-5, Schmorl's node. Had to take bed rest for a month, and the back pain and sciatica continued for at least two years. Even after that, I had problems, though the pain was much less.

Some time back when I had gone to see my doc, he said he suspected AS, but I didn't do anything about it. A few days back I met him again, and got an X-Ray; it shows the lower vertebras are fused. I'll get the blood test done in a few days; what I'd like to know is whether the AS will continue moving upwards or will it stop at the point where it is now? Can medicines check the spread of AS midway?

Right now I don't feel much pain, just that I don't like sitting on a chair. More than 15 minutes and it starts to feel weird and maybe a bit painful but nothing as strong as the disc injury. I always slump in the chair, but with the disc injury I should keep the back straight. My back is stiff, I can't bend much, and in standing position, I can't even lift a straight leg half way up.

I don't have a copy of my earlier X-Ray and MRI pics on computer, but I've got the pics of the latest X-Ray:


Are there others here who have AS and don't have a full spine fusion?



  • I am a 29-year old female and was diagnosed with AS in November, but fortunately I do not have any fusing yet. I do have inflammation in my SI joints, which is a hallmark of the disease, and my bloodwork tested positive for the gene, along with elevated inflammatory markers.

    The problem with AS is that it is very unpredictable. Some people never end up with fusion, while others will fuse despite aggressive treatment. AS is an autoimmune disease, so there is no cure and it is often progressive. Treatment for it ranges from NSAIDs (Ibuprofen, Naproxen, Meloxicam, Diclofenac, etc) to DMARDs (Methotrexate, Sulfasalazine, and Plaquenil) to anti-TNFs (Humira, Enbrel, Simponi, Remicade, etc.) Due to my symptoms and the inflammation in my SI joints, my rheumy decided to put me on diclofenac (an NSAID) and Humira (anti-TNF), along with Prednisone as needed for flare-ups. I just started the Humira about 3 weeks ago, so the jury is still out on that.

    It is also important to know that AS is systemic, so it affects much more than just the spine. It can affect peripheral joints (my hands, feet, knees, and hips are all affected), and it can cause organ involvement as well...including the bowels, eyes, heart, lungs, etc. Uveitis or scleritis are common findings in the eyes, and Crohn's/Ulcerative Colitis are also closely linked with AS. Oh, and Psoriasis is another one found to be closely linked.

    Unfortunately there is no way to tell whether your spine will continue fusing (with or without treatment). The best thing you can do for yourself is make an appt with a rheumatologist, if you have not done so already. Learn as much about the disease as possible. Best of luck to you!
  • Got the blood results and showed them to the doc.

    HLA B27 is negative.

    The other reports that are not good are:

    CRP : 17.0 g/L (less than 10.0 is negative, more is positive)
    ESR (Westergren Method) :
    After one hour : 18 mm (normal range is 1 to 7 mm)
    After two hours: 32 mm (normal range is 7 to 15 mm)

    Haemoglobin : 11.3 gm% (normal range is 13.5 to 17.0 gm%)
    RBC count : 3.68 mill./c.mm (normal range is 4.6 to 6.2 mill./c.mm)

    Rest all, including Liver and Renal function test, are all OK.

    The doc said its Spondyloarthropathy, and prescribed meds for 10 days: Sulfasalazine, along with Naproxen and Famotidine. Napro is an NSAID, and I don't have any real pain so I'm not going to take it, and Famotidine is an antacid so I'm not taking that either. But maybe Napro is also necessary along with Sulfasalazine? I forgot to tell him I'm taking Propranolol 40 mg daily; will have to call and ask, though a net search doesn't show any serious drug interactions.
  • Glad your doc is taking you seriously and starting treatment. Even without the gene, you CAN still have AS, which is considered a spondyloarthropathy. Even if you do not have pain, you may still want to consider taking the Naproxen. NSAIDs are proven effective in slowing disease progression, which is very important, especially since you already have some fusion in your spine. And the Famotidine is generally prescribed prophylactically to prevent GI upset, since NSAIDs can be harsh on the stomach. I take Diclofenac (another NSAID) and Omeprazole/Prilosec to protect my stomach. Plus, I take Prednisone on occasion to manage flares, while I am waiting for the Humira to take effect, so the Prednisone and Diclofenac together can do a number on the stomach.

    There should not be any contraindication with taking the Propanolol with these other medications. The only thing to watch out for is that NSAIDs can raise your BP, as it did for me. I am also on a BP med because of it. Ugh!
  • I'm also taking Diclo; have been taking it all these years, though not everyday. In the beginning I ate up too many of them, and some time back when I used to take one every night so that I could sleep well, I had problems where my stomach just wouldn't hold anything, I would vomit it all out. I could take only ice-cream for two days, not even the regular dose of Propranolol. This happened about two to three times and it happened even though I would take Ranitidine (antacid) every time. After that I cut back on the Diclo. These days I don't feel much pain, and I don't take it until it becomes really necessary. I think I've taken 10 in February, and maybe one or two in January.

    One thing I noticed when regularly taking Diclo at night was that if I had taken it yesterday and day before yesterday, and didn't take it today, it would pain more. If I didn't take it the next day as well, I would have less pain. I think the body had become dependent upon or used to Diclo.

    There is also a psychological element involved: when I feel stiff when going to bed, I think (tell myself) that there is no problem, that there is no spasm and the pain is just "leftover" memories of the previous pain, and this often helps. In 2001, I had a panic attack where I had difficulty breathing; first time it happened was early in the morning, because in those days, I'd take Diclo at about 9 PM, and it would wear off in about 6 hours, and the sciatica would wake me up, and then I'd start breathing slowly to go back to sleep. So I was breathing deeply and slowly and I thought what if the breathing stops and then I felt a heavy weight on my chest and couldn't breathe. Started taking a small dose of Alprazolam every night after that, and some three years later, took Fluvoxamine. What I do remember from that time is that the breathing difficulty was really scary and I had prayed that it should go away because the pain was still manageable but inability to breathe felt like you are about to die.

    I've searched for a lot of stuff regarding this, and I've found something called TMS (Tension Myositis Syndrome), and again I've benefited from that. See if it helps you. Are you in constant pain if you don't take the painkillers?

    I have off and on pain (very less) in the knee joints and in the last two left ribs.

    I talked to my doc; he says Propranolol is alright with the Sulfasalazine.
  • Yeah, you really have to be careful with all of these NSAIDs, as they can do a number on the stomach. Perhaps you need a stronger antacid, such as Nexium or Aciphex. I tried Zantac (Ranitidine), but I had terrible heartburn/gastritis from the meds. I switched to Omeprazole once a day, and it has been a lifesaver for me.

    I do this as well...I tell myself I am not really in pain and that I just overdid it. Fortunately I really do not take pain meds unless it is unbearable. I take the diclofenac 3 times a day, as prescribed, but it really does not do much for my symptoms. Or maybe it does...I don't know. I have been on it since I was diagnosed in November. But I was also started on Prednisone a little while later for a bad flare-up, and I have not been able to get off of the Prednisone for more than a few days.

    The prednisone is the biggest thing that helps me with the pain when I am in a flare. I am hoping once the Humira kicks in (it can take up to 3 months), I will not need the Prednisone anymore. I am currently on a really high dose and am working on weaning down, which is proving to be an extremely painful process. So, I have been taking pain meds to get me through.

    Generally speaking, without the Prednisone, I am in constant pain, but it is usually manageable without having to take any pain meds. My back does bother me, but for me (women tend to manifest differently when it comes to AS), it is the joint pain that is the worst. With AS comes something called enthesitis, which is inflammation of the tendons/ligaments that attach to the bones. Unfortunately I have it pretty badly in my hands and my feet. In fact, in November when I had that flare-up, my hands had gotten to the point I could barely use them, which is how I ended up on the Prednisone. Both my hands and feet/heels get painful, red, and swollen. I also have problems with my knees, hips, and various other joints.

    I consider myself blessed, as it could always be worse. Fortunately I do not have any fusion of the spine, at this point. Also, it may have taken me 10+ years of suffering with mysterious symptoms to finally be diagnosed, but at least we now know what the "beast" is, so now we can work on treating it.

    I am actually in the process of taking matters into my own hands. Since being diagnosed, ironically, I feel more out of control than ever. I feel like I am just a passenger in this game of life, as the doctors keep throwing more scary meds at me. A couple of weeks ago I was having terrible back pain that left me unable to walk and in the hospital for 3 days, which is how I ended up on the super high Prednisone. I did great on that and it helped with the back pain, but now as I am tapering down, I feel as if my body is revolting, and I cannot stand it. So, I am now looking into starting water therapy/aerobics, purchasing a recumbant exercise bike, and starting on a healthier diet with less processed foods and refined sugars. I feel as if I need to do SOMETHING, other than popping 20+ pills/day (yes, now that I am on the Prednisone, it is at least 20 pills/day...I have lost count).
  • You seem to be in more pain now. :( But this is always a phase that passes.

    I used to think my injury is really serious, and if I compare myself with normal people, it is pretty serious, but then when I look at all the X-Rays and MRIs on the net, and see broken bones that have to be held in place with screws and treated with epidural injections, I feel I'm lucky to get away with just this much. Those with such injuries/illnesses should change their definition of pain: if you can watch TV or read a book and forget the pain, its not strong, but if you can't divert your mind elsewhere, that's the only time you take a painkiller.

    Back in 2000/2001, I had a dream one night where I was about to enter a lift (elevator) and it suddenly moved down and I was getting cut up from the waist and it was really strong pain I felt, and I thought good, it'll be over soon, and then I woke up with a jerk and there was zero pain. Later I thought, isn't the actual pain enough without the mind simulating it in sleep? But we can turn it the other way round and use the mind to our advantage. They call it mind over matter. I remember reading that when the Chinese imprison and beat up Tibetan monks, the monks start praying and reach a state where they hardly feel anything.

    And since you said you need to do something, you might want to take a look at the karma theory. I don't know where you live or what religion you belong to or what set of beliefs you have, but I live in India, I'm a Buddhist and I've always believed in karma, even though I haven't done anything to get rid of whatever wrong stuff I did in my past birth(s). :grin:" alt=":grin:" height="20" />
  • Yes, unfortunately the pain has been much worse these days, but I believe a lot of it has to do with all of this medication. I went from taking no meds to taking way to much. It's been even worse now that I am weaning off of the Prednisone.

    I, too, believe in the art of distraction. Even if I am able to get my mind off of the pain long enough to fall asleep, then I will not take pain meds. Many others here will say to stay on top of the pain and not let it get to the point of no return, which is fine as well, but I, myself, would rather only take it if the pain is so bad I cannot escape from it. And thankfully for me, I have a pretty high pain tolerance, so it takes a lot to get me to that point. I have lived with the pain of this disease for so long (even though I was only diagnosed a couple of months ago), that I suppose I am just used to it. And having 3 kids to chase after all day long, is usually good enough distraction for me!

    It sounds like you have a positive attitude about all of this, which will certainly help you in the long-run.
  • I read some of your previous posts, one of which states you bent down to pick up your child and the pain started. So was it that which caused the herniations or some injury? I earlier thought you had AS for a long time but the doctor misdiagnosed it.

    What kind of heart problem do you have? I have MVP grade 1, which is nothing but I do get tired after doing exercises, especially in summer, and the collar bone often throbs a bit.

    I don't really have a positive attitude, but I keep thinking of developing one, and I've been thinking for the past few years.
  • I am also HLA-B27 negative, so was diagnosed with 'some sort of spondyloarthropathy'. My rheumatologist goes from AS to Psoriatic Arthritis, depending on what my symptoms have been since the last time I saw him. I started out on Sulfasalazine, but it made me violently ill. From there we went to Methotrexate, which gave me SOME relief, then just stopped working. (Just FYI, even though the MTX was an injection, I also had to take a stomach protectant with it.) I always had one or two days with terrible nausea and extreme fatigue after the injections, which was miserable. The next step was Enbrel. Again, I had some relief (especially knee pain and muscle spasm relief), but had one of the worst flare-ups ever in November, so I went off that one and waited for approval for Humira.

    I have had two doses of Humira now; it will probably be a while before I know whether it's going to help or not. My SI joint pain was out of control, so I had a nerve block and SI injections almost two weeks ago, which are going to cloud things a little with figuring out what is actually giving me relief, but I needed something to help me along, even though it's temporary.

    Bhargav, though we don't like to take NSAIDs, sometimes it's necessary to get the inflammation down and under control, because THAT is what causes most of the joint damage (the inflammation itself). I am on a prescription NSAID called Flurbiprofen, and I take Rabeprazole to protect my stomach.

    I have just started some gentle swimming and gentle yoga, which I'm hoping will be okay. With the nerve block, my low back isn't doing too bad, but that can change in an instant, as we know! I walk every day (I have a border collie who insists that we do that!) and try to stay as active as possible without hurting too much more at the end of the day.

    I have two fantastic physiotherapists who help keep my joints mobile and my pelvis level; when it is 'out', it causes a lot more grief. I go for IMS treatments (similar to acupuncture, but into muscles, etc.) to ease off the spasms that take hold, and when I can manage it, I go for massage.

    It is a full time job dealing with all this chronic stuff, but I think it's worth it!!

    Good luck, you two.


    "Every day may not be good, but there is something good in every day."
  • It's "nice" to see that there are others with AS here. As you can see I had two recent surgeries, but there were many years with meds., Enbrel, now Humira. The Enbrel helped for a number of years, now Humira is helping some, but not as much as it used to. I walk, and hopefully will start aqua classes, which helped me with some strength and flexibility. I recently tried accupuncture which seemed to help some.

    Take care, and good luck.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • I have had symptoms of AS for a long time, ranging from back pain to joint pain to various systemic symptoms. In October 2010, I had suffered acute pain after lifting my daughter. A subsequent MRI showed herniations from T5-T11, however, they do not feel the lifting injury caused all of these herniations, rather, I had them beforehand and the twisting/lifting motion aggrevated it. The neurosurgeon I had seen as a first opinion prior to my surgery was the first one to mention AS to me, based on the fact that I have so many herniations in the t-spine, which is supposed to be the most stable of the 3 spinal regions. Later on that surgeon explained that with AS the ligaments become weak/damaged, which puts you at increased risk for disc herniations. I really stumbled on this diagnosis. I had heard of AS many years ago, but I had always heard it was a man's disease and never gave any thought to it. After the NS made the preliminary AS diagnosis, I decided to seek the opinion of a rheumatologist, and the rest is history.

    As for my heart, I had fainted in August 2010 and ended up in the ER. They were going to discharge me, as it appeared I had what they call a vasovagal episode due to coughing. Well, they did an EKG and the ER doctor was alarmed because mine was abnormal. He said my EKG looked like what they would see in an 80-year old, and he did not feel comfortable sending me home without consulting with a cardiologist. I was admitted and the cardiologist diagnosed me with Wolff Parkinson White (WPW for short). Basically it's an issue with the electrical pathways in the heart. I have an extra pathway, which causes the abnormal EKG. It is not a problem as of now, but in people with WPW, it can lead to dangerous arrhythmias. Fortunately I have not had any issues, but I follow up with a cardiologist once a year and have regular holter monitors done.

  • P.S. It definitely is nice to see we are not alone. I just took my third dose of Humira today. However, I am currently tapering down from Prednisone (at 60 mg/day), so the jury is still out. I can't wait to get off of the Prednisone!
  • Prednisone can really have an impact with impact on sleep, jitteriness, etc. I hope the Humira helps.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Met my doc yesterday. He asked me to continue taking the meds for another 15 days (Naproxen twice and Sulfasalazine 1000 mg once a day). I've been facing a bit of a gas problem, so I've switched from the Ranitidine 150mg to Omeprazole 20 mg. I take it with the Napro, is it necessary with Sulfasalazine as well?

    Another thing I wanted to ask, what exactly is Sulfa going to do - is it going to break the fusion and return the spine to its previous state, or will it just stop more fusion from taking place?
  • Not sure about the Omeprazole and Sulfasalazine, but typically PPI's are prescribed along with NSAIDs prophylactically. NSAIDs can be harsh on the stomach, and I can attest to that. I was just taken off of Diclofenac (another NSAID), because I am dealing with a bad case of gastritis. I am also on Prednisone, so I am sure that is the main culprit. They sped up my taper to get me off of it sooner, but my stomach is feeling it.

    The sulfasalazine will not reverse the damage caused by the AS. In fact, unfortunately, no medication can reverse the damage. The goal of medication/treatment is to slow the progression of the disease. For some that means stopping further damage; for others that means buying more time. In severe cases, the disease continues to progress despite medication. The newer, gold-standard for treatment are the biologics/anti-TNF's (Humira, Enbrel, Simponi, Remicade, etc). The DMARDs (Methotrexate, Sulfasalazine, and Plaquenil) are often used after failed treatment with NSAIDs, and many insurance companies will require that patients use DMARDs first, before progressing to the anti-TNF's. However, many doctors push for getting patients on anti-TNF's sooner, as they have been found to slow progression better.

    I had tried NSAIDs alone for a couple of months but was still having bad flare-ups that were requiring Prednisone. Fortunately my insurance company approved of the Humira without requiring me to try one of the DMARDs first. I do not have fusion of my spine, but I have inflammation in my SI joints, along with evidence of enthesitis in my hands, feet, and other joints.
  • Went to the doc again. He reduced the Sulfasalazine dose to half (500 mg) per day, and has stopped Naproxen 500 twice a day and instead started Meloxicam 15 mg once a day. Wikipedia says it has analgesic and fever-reducing effects, but I have neither pain nor fever. Do all these NSAIDS have the same purpose or specific ones?

    I had thought I'd have to take the Sulfasalazine for years to stop further ankylosing. Ever since I started taking it, I have started sleeping more.
  • All NSAIDs have pain-relieving and fever-reducing properties. However, the acronym NSAID means non-steroidal ANTI-INFLAMMATORY drug. The reason the doctor wants you on it is not for pain or fever, rather for it's anti-inflammatory properties. With AS, there is widespread inflammation in the spine and other joints, which causes destruction to the joints and ankylosis, or fusion of the spine/joints. So theoretically, if the inflammation is reduced, it will help to slow down the disease process. I hope I am making sense.
  • Another blood test (last one was on the 14th of February).

    31 mm after 1 hour (normal is 1 to 7 mm; last time it was 18mm)
    47 mm after 2 hours (normal is 7 to 15 mm; last time it was 32 mm)

    CRP: 15.8 g/L (last time it was 17)

    Haemoglobin: 14.1 (normal is 13.5 to 17.0; last time it was 11.3)
    RBC Count: 5.56 (normal is 4.2 to 5.4; last time it was 3.68)
    WBC Count: 9700 (normal is 4000 to 10,000; last time it was 6400)

    Haven't shown the report to the doc yet, as he is down with fever!
  • Met another doc today; he said my chest expansion is less than 2 cm. He also said vertebras become squared in AS and that my SI joint is also fused.

    He's recommended seeing a rheumatologist, and checking for occult blood in stools.
  • to join the group. I have been taking Humira for 2 years. It helps a lot. I had both SI joints injected with steroids and it has been several months without lower back pain. I do have lots of pain in my shoulders,elbows,knees and ribs.

    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • Injuries to the intervertebral discs of the lumbosacral spine are invoked as a causative factor in one of the most common health problems in the United States low back pain. Of the many possible etiologies of LBP, the intervertebral disc has been implicated as a more frequent source than muscular strain or ligamentous sprain. Although no single injury to the intervertebral disc has been unequivocally identified as a pain generator, theories of its involvement are commo
    david flora
  • BhargavJ said:
    Got the blood results and showed them to the doc.

    HLA B27 is negative.

    The other reports that are not good are:

    CRP : 17.0 g/L (less than 10.0 is negative, more is positive)
    ESR (Westergren Method) :
    After one hour : 18 mm (normal range is 1 to 7 mm)
    After two hours: 32 mm (normal range is 7 to 15 mm)

    Haemoglobin : 11.3 gm% (normal range is 13.5 to 17.0 gm%)
    RBC count : 3.68 mill./c.mm (normal range is 4.6 to 6.2 mill./c.mm)

    Rest all, including Liver and Renal function test, are all OK.

    The doc said its Spondyloarthropathy, and prescribed meds for 10 days: Sulfasalazine, along with Naproxen and Famotidine. Napro is an NSAID, and I don't have any real pain so I'm not going to take it, and Famotidine is an antacid so I'm not taking that either. But maybe Napro is also necessary along with Sulfasalazine? I forgot to tell him I'm taking Propranolol 40 mg daily; will have to call and ask, though a net search doesn't show any serious drug interactions.
  • JoshGCJJoshGC Posts: 5
    edited 02/17/2015 - 9:32 AM
    I'm a 42 year old make diagnosed with AS in 99'. My SI joints are completely fused, L4/5 is over 50% fused and have active fusing in my right hip, both big toes and ribs.

    Once a joint has fused, pain goes away. In other areas of active disease, pain can be exteme at times. NSAIDS don't work very well for me . Did a year and a half on Enbrel before it stopped working and currently treating my AS with Remicade infusions and having good results thus far. Unfortunately, dealing with a T7/8 degenerative, compressed disc causing bone inflammation that is the cause of most of my current pain.

    Hope your AS stays controlled!!
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