Seeking a Second Opinion on Diagnosis After a Confusing Rheumatology Visit
I find myself feeling quite perplexed regarding my latest appointment with the rheumatologist, particularly concerning a possible diagnosis of ankylosing spondylitis. Are my symptoms connected to this condition? When I posed questions to my doctor, his response was rather dismissive, leaving me without clear answers. I have been experiencing numerous systemic issues such as frequent migraines, bouts of dizziness, near-fainting spells, joint discomfort, cyanosis, intermittent fevers, skin rashes, and an increase in vascular changes. My HLA-B27 test results came back positive, which has led my doctor to suspect ankylosing spondylitis. However, I had an MRI of my sacroiliac joints two years ago, and it showed no signs of ankylosing spondylitis. Now, due to the emergence of fevers, he recommends repeating the imaging. The most troubling symptoms for me revolve around persistent dizziness, near-syncope, and an unshakeable sense of being cold. This presentation does not align with what I typically associate with ankylosing spondylitis. Notably, my CRP and ESR levels have consistently remained low. Could ankylosing spondylitis really lead to these additional symptoms, including episodes of syncope? I suspect the underlying cause may be autoimmune in nature, yet besides the genetic marker, my symptoms don't fully align with this diagnosis. It’s also worth mentioning that rheumatoid arthritis and Sjögren's syndrome are present in my family history. Any insights or advice would be greatly appreciated. I am a 39-year-old female, weighing 155 pounds.
Answers (1)
12/15/2025, 10:50:39 PM
OpenHealth AI
It’s understandable to feel perplexed after a medical visit that didn’t provide the clarity you were seeking, especially with concerning symptoms and a potential diagnosis like ankylosing spondylitis (AS). Here’s a concise breakdown of your situation:
Main Points:
- Your symptoms include migraines, dizziness, fainting spells, joint discomfort, and skin rashes, which may not directly align with ankylosing spondylitis.
- A positive HLA-B27 test does suggest a predisposition to AS, but it’s not definitive on its own.
- Repeating the MRI is a reasonable step, especially in light of the new symptoms and your family history of autoimmune conditions.
Explanation
Ankylosing spondylitis primarily affects the spine and sacroiliac joints, leading to pain and stiffness, especially in the lower back. While it can be associated with systemic symptoms, such as fatigue and mild fever, the severity of your dizziness, near-fainting, and feelings of being cold are less typical for AS.
Given your low CRP and ESR levels, which indicate a low level of inflammation, it's also worth exploring other possible causes for your symptoms. Factors such as neurological conditions, vasculitis, or even other autoimmune disorders may need to be considered, especially with your family history of rheumatoid arthritis and Sjögren’s syndrome.
Next Steps
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Prepare for Your Follow-Up:
- Document a detailed symptom diary that tracks your symptoms, their frequency, triggers, and any related changes. This can be invaluable for future medical appointments.
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Consider Second Opinion:
- If you remain uncomfortable with your rheumatologist's dismissive responses, seek a second opinion from another rheumatologist or a specialist who focuses on autoimmune diseases.
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Discuss Symptom Management:
- Specifically address your dizziness and fainting spells with your healthcare provider. It may involve monitoring your blood pressure and hydration levels, or evaluating for conditions that affect your cardiovascular health.
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Further Investigations:
- Make sure to discuss any additional tests that may give a clearer picture of your symptoms, such as blood tests for other autoimmune markers, and imaging that might help assess for conditions like vasculitis.
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Lifestyle Adjustments:
- Focus on hydration and nutrition, which can support your overall health. Regular, gentle physical activity can also help manage joint discomfort.
Feel assured that understanding your symptoms and getting the right diagnosis is a gradual process. Continue advocating for yourself, and don't hesitate to ask all your questions until you feel satisfied with the answers. Let me know if you need further information or specific advice on any of these points.
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