45y/o,f,with severe back pains. Positive HLA-B27,SS-A,SS-B and minimal Deg.changes in LS-spine.This is a tall nurse with Dry eyes and mucosas. Currently not responding to NSAID,COX2,Tylenol,heat,PT. Is Immunosuppressants indicated?
The key here is to determine if the etiology of her back pain is due to inflammation. Sed rate and/or CRP is often helpful. Since 8-10% of the Caucasion population in the U.S. is HLA-B27, HLA-B27 positivity alone does not mean that the patient has ankylosing spondylitis. X-rays of the sacroiliac (SI) joints and if negative MRI scan of the SI joints should be done to document sacroilitis. If indeed the back pain is due to inflammation, agents such as sulfasalazine or a TNF inhibitor might be indicated.