Dr. Elie Karam
Chair of the Board, Canadian Spondylitis Association
Mechanical back pain from strain, injury, or overuse is common, but persistent inflammatory pain could signal an autoimmune condition like spondyloarthritis.
Spondyloarthritis (SpA) is a form of inflammatory arthritis affecting people mostly between the ages of 25 and 30. The journey to diagnosis and proper treatment can be slow.
Dr. Elie Karam, 35, knows this only too well. In April of 2016, while doing his residency in orthopedic surgery, he started having pain in his back and later in his shoulders. “Some days I would wake up totally normal and other days I couldn’t do basic things like dressing,” he says.
While SpA was suspected, it took two years to get a diagnosis. “It’s ironic because here I was surrounded by experts in the musculoskeletal field and doing my residency in orthopedic surgery, yet we all missed it,” says Dr. Karam.
Negative tests don’t rule out the condition
Part of the problem was that the X-rays, lumbar MRI, and typical HLA-B27 inflammatory marker test all came back negative. “About 10 percent of people with SpA have a negative B27 marker,” says Dr. Karam. Thankfully, his wife, also a physician, had a gut feeling it might be SpA. Deciding to trust her judgment, Dr. Karam requested a new MRI centred on sacroiliac joints, which confirmed the diagnosis.
It took another year to get the right treatment of biologics, but Dr. Karam finally has his life back. He’s now Chair of the Board of the Canadian Spondylitis Association (CSA), hoping to help others with SpA get earlier diagnoses. “We spend years going to the doctor, getting negative tests, and worrying that people think we’re faking it. But we’re not faking being sick, we’re faking being well,” he says.
Dr. Karam advises others who have had inflammatory pain onset before age 45 for more than three months to talk to their doctor. And don’t be afraid to ask for help. “The CSA is here to support and empower you to live better with the disease,” he says.