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When to test B27

Hi. I have inflammatory-type lower back pain going back many many years, which recently became much more severe.
I am on Humira for psoriatic arthritis but it seems to have stopped working, or my back pain is just getting worse.
I recently had an MRI on my SI joints. I requested the results but the rheumatologist won't let me have them as she wants to discuss it with colleagues first.
From what I know, everything about this pain fits with sacroilitis; I just have to wait and see what the MRI says.
In years of having this inflammatory lower back pain and being under rheumatology I've never been tested for HLA B27.
At what point should they check B27, if at all? If the scan shows something, should I expect that to be the next test? I have been fobbed off regarding my back pain for years. They are only interested in visibly swollen joints.
I'm taking the maximum dose of naproxen every day, which helps but not completely and doesn't last me through the night - I still wake up feeling like my back and hip is broken.

  1. We are not doctor and are not able to give medical advice. (trust me you do not want me to give it ).
    As a person with multiple rheumatic conditions, I think it may not matter so much. Others will disagree and I will let them comment. But for me (just me) I treat my various autoimmune conditions like a giant simmering stew. Regardless of what I have, I need what works. You mentioned Humaria might be losing its effectiveness. If so your rheumatologist will be able to address with you the various options. Likely no medication will be perfect. In my case it was pick what works best. I had to make some choices. Does this hurt more or less than that. In order to decide your rheumatologist may wish to do additional blood work, or look at other factors like PT or OT.
    I guess what I am saying is that in my case I had to relax and let it flow. I hope you might find that as well. IN the end it eventually got to where it had to be.

    rick - moderator

    1. Sorry my question was about the normal point at which B27 is tested. So based on other people's experiences. I wasn't asking for medical advice.

      1. Hi. Thanks for your reply. I haven't asked my doctor, partly because of limited contact with my rheumatologist, and partly because I don't want to jump the gun or second-guess what they might be looking for.

        My understanding of HLA B27 is such that it is not a particularly useful test to have unless there is already a strong suspicion or evidence of AS. There is a Bayesian approach to using it as a diagnostic tool, and taking it too early could render it meaningless.

        So I suppose I'm asking in anticipation of what the next step might be.

        I do not know what my MRI shows, but the fact the doctor wants to discuss it means there is something to discuss. I want to be on the front foot when I finally do get those results so that, whatever it shows, I know what questions to ask.

      2. - It's always good to be prepared! Kudos to you for doing your reseach and asking questions. We are our own best advocates! We'll be thinkin' of ya and hope you get the answers you deserve. I hope you're able to feel some comfort and relief soon. -Anthony (Team Member)

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