In most cases, it is by symptoms. They do x-rays. Mine were considered normal by the radiologist, but the rheumatologist felt there was some very early irregularities within the SI joints. They also test for the HLA-B27 gene, which is positive in most people with AS. But with enteropathic arthritis, it is only about 50% positive. CRP may be elevated, but it is non-specific for any inflammation. MRI may show some changes (I had some ligamental inflammation in the lumbar spine). DEXA scan does not do it. It's difficult because you also have the bowel symptoms. If you have a history of plantar fasciitis and/or Achilles tendonitis, those are strong correlations.

But, generally, it is the constellation of signs and symptoms that lead to the diagnosis. It is very insidious and gradual. Of course the treatment is pretty much the same as what you are on. Sometimes they add methotrexate to Humira (or Enbrel or Remicade) treatment.

Jan

Okay just an update! I feel SO MUCH BETTER!!! It was getting really awful there for a while. I felt so incredibly swollen "down there" and I was starting to get scared. That said, since starting the Levaquin, no more pelvic pressure, bloating, hardly ANY gas, which is a major change for me, I'm going to the bathroom about 3 times a day, everything is so much better. I wonder if I've had this going on for a while actually. So I suppose it was pouchitis. Whatever it was I'm just glad the med. is helping! Thanks to Jan and Shelby for their advice
PS. I'm also eating little to no sugar and caffine and back on the yoga.

Glad you're feeling better Liz