The one symptom these friends shared was almost always “low back pain,” and all had been “diagnosed” locally with HLA-B27 testing and CT or MRI of the sacroiliac joints, which generally showed lesions that were “less severe” and are often diagnosed in the early stages of ankylosing spondylitis, i.e.: seronegative spondyloarthropathy or undifferentiated spondyloarthropathy. However, we have found that many of these friends have nothing of the sort, much less ankylosing spondylitis. Why do you say that? What is the cause of their low back pain? Here’s what you need to know. There is a high incidence of ankylosing spondylitis in China and abroad, which can be misdiagnosed by rheumatologists as ankylosing spondylitis. At first glance, many friends do not understand, “Anxiety and depression is a psychological problem, how can it be related to low back pain? And I am not so depressed, nor do I want to live ah. In fact, because of social competition and survival pressure, the incidence of anxiety or depression is very high in modern society, and recent studies in Beijing show that the lifetime prevalence of depressive disorders can reach 6.87%. Anxiety and depression are very common in life, people often say that neurasthenia, plant nerve dysfunction is actually a kind of anxiety and depression, these friends often have insomnia, headache, dizziness, tinnitus, chest tightness, loss of appetite, abdominal pain, fatigue, depression, irritability and many other manifestations, especially it can lead to hypersensitivity to the sensation of pain in the brain, ordinary people with mild trauma or strain injury to the spine, joints, etc. may feel The ordinary person with mild trauma or strain on the spine or joints may feel mild pain, but these conditions may feel very painful if they happen to such friends, and are often accompanied by abnormal sensations such as localized soreness, weakness, fear of cold, numbness, and conscious joint movement with a ringing sound. After some doctors diagnose or suspect the diagnosis of ankylosing spondylitis and other diseases, these friends are often fearful and anxious, searching for knowledge on the Internet all day long, and after seeing some content about ankylosing spondylitis and easy disability in the future, they become more and more worried and worried, and the pain is getting heavier and heavier, and the pain is usually not serious before the misdiagnosis, but after the misdiagnosis, because of the psychological factors of anxiety and depression, the pain The pain is usually not severe before the misdiagnosis, and after the misdiagnosis, the pain often feels worse because of the psychological factor of anxiety and depression. After wrongly receiving some treatment for ankylosing spondylitis, the pain is often not relieved, leading them into a deep depression of anxiety. There are many reasons why doctors misdiagnose this type of low back pain, and I will discuss three of the main reasons below. 1, the primary reason is that most rheumatologists in China do not yet know that “anxiety and depression can cause pain” These doctors often face these low back pain friends only think of ankylosing spondylitis and spondylolisthesis and other related diseases, especially after the patient friend after the orthopedic surgeon ruled out disc herniation, spinal stenosis and other serious orthopedic diseases. These rheumatologists often diagnose them as ankylosing spondylitis or spondyloarthropathies, etc., without finding a reasonable cause of low back pain. Moreover, patients with this type of low back pain often have sleep disorders due to anxiety and depression, and they often feel more severe low back pain at night when they have insomnia, which is easily misdiagnosed as “inflammatory low back pain”, which is also an important reason why this type of low back pain is misdiagnosed as ankylosing spondylitis-like disease. Secondly, misinterpretation of HLA-B27 gene positivity is also a common cause of misdiagnosis of this type of low back pain. Patients with low back pain are often diagnosed or suspected of being diagnosed with ankylosing spondylitis-like disease because of the presence of HLA-B27 positivity, but is low back pain combined with HLA-B27 positivity necessarily ankylosing spondylitis-like disease? The answer is no. HLA-B27 positivity only adds to the diagnosis of ankylosing spondylitis, but is not conclusive. And there are some patients with ankylosing spondylitis who are negative for HLA-B27. 3. Finally, misinterpretation of sacroiliac joint images is another common cause of such misdiagnosis It is important to diagnose ankylosing spondylitis by looking for inflammation of the sacroiliac joint, and how to determine whether it is inflamed is primarily through imaging, that is, X-ray, CT or magnetic resonance imaging (MRI). The normal sacroiliac joint structure may also have slight blurring and sclerosis, especially as the sacroiliac joint becomes degenerative with age, so it is not easy to determine whether a sacroiliac joint is “inflamed”. Because of the fear of underdiagnosis, radiologists in China generally have the problem of “over-reporting”, which means that many minor suspicious abnormalities without clinical significance are written on the report and described as either minor abnormalities or definite inflammation. Some rheumatologists who are not very good at reading CT or MRI themselves can only use the radiology report as a basis for diagnosis, which has led to the misinterpretation of many sacroiliac joint images in China, with minor abnormalities that were not considered to be problems being interpreted as “inflammation of the sacroiliac joint”, which is used as an important basis for the diagnosis of ankylosing spondylitis, thus leading to misdiagnosis. Therefore, whether a patient with low back pain is indeed suffering from ankylosing spondylitis-like disease, it is important to emphasize the presence of the substance of “inflammation”, i.e., significant joint swelling and pain and tendon attachment point swelling; sacroiliac joint and spine imaging clearly showing the presence of inflammation; and elevated C-reactive protein or sedimentation, markers of inflammation. In the absence of clear evidence of “inflammation” as described above, your low back pain may not really be ankylosing spondylitis, and if you have some degree of anxiety or depression, you may be more appropriately seen by a medical psychologist or psychosomatic physician.