Ankylosing spondylitis often misdiagnosed among young patients
FORTH WORTH, Texas — Ankylosing spondylitis may be the most misdiagnosed inflammatory arthritis conditions, as it often occurs among young patients whom health care providers may not associate with the disease, according to Denise Smith-Hauser, NP-C, from the Cleveland Clinic.
“We don’t always think that when someone young is experiencing back pain or inflammation, they could potentially have this inflammatory arthritis condition,” Smith-Hauser said, addressing a session at the Rheumatology Nurses Society Annual Conference. “However, we ask about family history – specifically whether they have a family history of one of the genetic markers, including the surface antigen HLA-B27.”
According to Smith-Hauser, HLA-B27 is strongly associated with ankylosing spondylitis and other spondyloarthropathies, as well as several ocular conditions and systemic diseases with specific ocular manifestations.
In addition, the antigen is commonly found among Caucasian patients, with about 80% of Caucasian patients with ankylosing spondylitis testing positive for HLA-B27.
“I have seen patients who are cheerleaders, football players and, interestingly enough, many pharmaceutical representatives, who have been diagnosed with ankylosing spondylitis because of the education that we now have,” she said.
Smith-Hauser noted that nurses and other providers should treat patients with early ankylosing spondylitis with physical therapy, as advanced forms of the disease can result in spinal fusion.
“Send those patients to physical therapy,” she said. “If they fuse, they are not going to be able to stand back up.”
In addition, Smith-Hauser recommended that rheumatology nurses continue to educate themselves on basic immunology and autoimmune diseases, but to also keep explanations simple for patients, so as to not overwhelm them.
“The immune system is very complicated, and the more you study, the more it makes sense,” Smith-Hauser said. “I know that when you are trying to explain the immune system to patients, you don’t want to overwhelm them, but instead start a conversation with them, about what we do, why we do it and what we check and why.” – by Jason Laday
Smith-Hauser D. Basic immunology and how it related to autoimmune disease. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure: Smith-Hauser reports speaking fees from AbbVie, Amgen, Novartis and BMS, as well as consulting fees from AbbVie, Amgen and Novartis.