Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group fusion

Hi, how long from diagnoses or symptoms till you could see fusion on x-rays particularly in the SI Joints.

THANKS!

Hello, Evan:

This is a very individualistic thing. Sometimes fusion will appear as early as six years, but some people never fuse; it cannot be used as a primary diagnostic criterion in AS especially Early AS.

HEALTH,
John

Hi John, i should of been more clear...how long on avrg till an xray picks up calcification (white scaling look) wouldnt it not fit into the definition of AS if there is no calcification in the Si joints/spine. wouldn't it just be some sort of spondyloarthropathies but not technically AS? just id think if its been over 8 years you would see something.

Hi, Evan:

All of the "spondyloarthropathies" are just interim descriptions of AS but dancing around the fact that fusion has not yet begun; there is really just one mechanism for the inflammation: KRA (Klebsiella-Reactive Arthritis). This is totally independent of if and where the fusion is detected or even really begun.

It is true, the hallmark of AS is SIJ fusion, but not everyone with AS will fuse or fuse there first. The state of the diagnostic puzzle is regrettable in that people have such a misunderstanding of the B27 antigen (and other AS-genic MHCs) in addition to the value of X-ray evidence (or lack thereof); more important is patient history and basic mobility tests.

HEALTH,
John

In my case it was caught within 3-4 years in my left SI joint.

I had my first symptoms in left SI hip at summer school while in college... I was still 22. I thought it was the bed I had to use at apartment for summer school... but then when I was back at my bed at home still had issues.

AS went away... returned in my right hip and low back at about 25... took about year to get properly diagnosed when they took x-rays of back and hips. They saw fusion in my left hip... none at the time in my right hip that was extremely painful.

As John said.. can be individualistic.

Tim

From reading your post, you obviously know that the hallmark of Ankylosing Spondylitis is grade II Sacroiliitis (grade II: minimal sclerosis with some erosion) NOT fusion. As you pointed out, a patient without Radiographic Sacroiliitis can properly be diagnosed with another form of Spondyloarthropathy but does not technically have AS.

The old estimate of progression typically said that it could take up to 10 years from first symptom to Radiographic evidence of Sacroiliitis. Some patients progress much quicker then that. (My son went from MRI evidence of inflammation, but no X-ray evidence of sacroiliitis to grade 2/3 sacroiliitis in less then 3 years.) The old estimates were from before the ASAS criteria was published and before there was a standard for MRI use and interpretation. The estimates also predate the widespread treatment of patients without Radiographic damage. What impact would these changes have on estimates of progression? Without an updated study, I don't think we really know.

If you have had symptoms, but no progression of damage in 8 years, perhaps you will be one of the fortunate patients who never progresses to full blown AS.