Spondylitis Association of America Forums General Discussion General Message Board for Ankylosing Spondylitis and Related Diseases Bridging osteophytes???

Hi, I have a question. I have not been to the doctor in maybe three years and have been away from these boards as well. It kind of caught up with me and here I am but I find the terminology has changed a bit since I was around last. I was referred to physical medicine after some back x-rays and the doctor said my back was full of 'bridging osteophytes typical of spondylitis'. I had not heard this term of bridging osteophytes before and thought osteophytes were the opposite of AS. And then the radiologist wrote the report on the x-rays and said there was no evidence of spondylolyses or spondylolisthesis whatever those are but lots of other degenerative damage. I see the rheumatologist tomorrow for the first time in years and am clueless as to how to approach this. I have been dealing with AS symptoms for nearly 30 years and was diagnosed by a doctor who is no longer around many years ago. My lower back and neck are giving me too much grief and I need to do something. Anyone understand 'bridging osteophytes'? Does they indeed go along with AS? And how are the biologics doing these days? I used to be afraid of the side effects.

Thanks,
Virginia

I'm not up on terminology either, but "bridging osteophytes" sounds like syndesmophytes to me since syndesmophytes bridge the gap between vertebrae.

Biologics have come a long way. Most of the really bad side effects have proven to be pretty rare, and rheumies are using them earlier in treatment, whereas they used to be a last resort choice.

Its impossible to diagnose syndesmophytes from plain film as even though they are pathologically identical to osteophytes, they occur inside ligaments. As Southernmoss said your bridging osteophytes are likley syndesmophytes and indicitive of AS. Spondylolyses or spondylolisthesis are arthritic changes. Spondy in a word means spinal.

The latest research indicates aggressive treatment immediately instead of slowly stepping up treatment.

The biologicals have been a miracle for me.

Good luck, hope you like your doctor.

Anna

Hi Virginia, I agree with the above replies. regarding TNFs there are now 5 indicated for AS and they are widely used around the globe. Hoping you have a good day and you find relief from your neck and back pain. Kindest, Rich

Thank you all for your wisdom. It definitely helped. I saw the rheumatologist today and he said bridging osteophytes could be osteoarthritis or AS, either one. He said at my age (50's) it would be expected to have osteoarthritis whether or not AS is there. He suggested Enbrol though because of all my history that goes with spondy stuff and I am going to go for it. It will be a new adventure. He said we would do a three month trial and that if things don't improve that means the pain is likely coming from non AS issues or from mechanical damage. I am looking forward to seeing if I can get some of my life back.

I hope that the Enbrel does work, but would point out that one anti-TNF failing to work does not prove that the pain is not being caused by AS. In clinical studies with "ideal" AS patients, about 25 to 40% of patients being treated with Enbrel did not see any clinical improvement (and the statistics are similar for all drugs in this class). That's because not every medication works for every patient. Humira worked wonderfully for my PsA, Simponi worked a little, and Enbrel did nothing at all. All three inhibit tumor necrosis factor, but what if we had only tried Enbrel and decided from there that my pain was all from, say, my fibromyalgia?

I agree with Mary. Each biologic has a different approach, and they don't all work for everyone. I hope the Enbrel works, but if it doesn't, talk with your rheumy about trying a different one.

Good point. I was thinking this as well. Then when I told my son the action plan he said that Enbrel did nothing for him but Humira really made a difference. I think the rheumatologist is thinking that at my age probably this is either osteoarthritis or mechanical. But I know the spondy stuff is always there.

The problem always is when the normal "aging stuff" both osteo and mechanical is accelerated by the spondy stuff. Even if the Enbrel (or later Humira or whatever bio) works because of the normal stuff, causing pain its hard to know if it really is working......