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Anterior Uveitis.... Ankylosing Spondylitis?

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  • Anterior Uveitis.... Ankylosing Spondylitis?

    Hi guys...

    Don (T11 complete) is being treated for anterior uveitis (the first time he has ever had this) which is not resolving and now has low back pain on the right side above his level of injury. The pain is so intense when he moves that he has been vomiting intermittently this weekend. His urine is clear. No fever. B/P is 126/69. No AD that I can see.

    Anyway... I know he's old for AS but it may be a possibility?? He has tried 800mg of ibuprofen which helped at first but now not so much. I gave him some flexeril in hopes that he can get some relief. He refuses to go to his internist until tomorrow.

    When I move his right leg the pain in the lower back is horrible. Could it be his hip and the pain is referred? We will run tests to look for the HLA-B27 marker for AS...

    Any ideas???? Help!


  • #2
    I waited out a night with a broken arm but a possible broken leg is different. If his doc has an emergency number try it and ask if he can call your ER to speed things up. I'd go. My husband has AS and was diagnosed at 18 or so by the marker; he's now 61. Serious pain when out of remission is normal especially around the rib cage as if someone is squeezing you to death. Vomiting is not.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.


    • #3
      I'm sorry to hear about Don's pain, and new diagnosis of uveitis.

      I think it is hard to tell what's going on at this point. You certainly can have leg movement that exacerbates back pain. It sounds like your husband needs a good physical examination, maybe an x-ray.

      And uveitis is definitely something that needs to be worked-up. Hopefully he is being followed carefully and frequently by a good ophthalmologist and a rheumatologist should be seen to try to figure out the cause of the uveitis (which can sometimes be seen with other rheumatologic disorders and infections as well). A primary care doctor alone cannot address these issues, but is certainly a good place to start. Does he have any other new/odd symptoms, or any rashes (things that can help diagnose what may be going on..)?

      Is there a reason your are thinking of AS right now? Has he already had x-rays that looked consistent with AS?


      • #4
        He is being treated by a good ophthalmologist. The anterior uveitis itself raises the question of AS with the association of the lower back pain. He's never had any significant pain in his lower back. I thought maybe a kidney stone but urine is clear? No recent films of the spine... last set about 2 years ago. He has no history of recent trauma to his right side.
        It's a mystery for sure. The flexoril seems to be helping more than the ibuprofen.

        Thanks so much for your replies...



        • #5
          You are being very smart about thinking of other causes of back pain.... especially in light of the vomiting. That's serious pain! Or something else going on.....

          It's good to hear his blood pressure is ok and he has no fever, but your thoughts of a kidney stone is a reasonable one too. Stones can hurt like hell. Urine may not always look bad initially.

          Usually a dislocated hip would not usually radiate pain up to the back, but I'm not sure where the pain exactly is in his back... But if his hip looked out of alignment (i.e. if when lying on his back he wants to hold his leg externally rotated at the hip and it hurts like hell to straighten it), then that would be a concern. But if no recent trauma, you would wonder why that would happen.

          Sorry... I know how scary it is to be alone at night worrying about a family member. Sue had a great idea about calling your husband's doctor for input.... most doctors have an answering service and the doctor on call should get back to you, and at least give you some guidance about whether to take him in sooner.

          And I still think you should keep your "big picture" diagnosis for what is going on the uveitis a bit broader... hopefully they will do xrays, and run more tests then just the HLA marker (eg. at least something to look for sarcoidosis, or maybe some of the infectious causes).

          Good luck. It will be ok.


          • #6
            Thanks hlh and sue....i'll let you know what happens. He's resting comfortably with the flexeril on board.

            Thanks again...