I have been struggling with low back pain since I was 18. As I have aged (I am now 32) the frequency and severity of occasions have increased. I have been to the doctor multiple times over the years. When I was 19 I saw an orthopedic surgeon who told me I was HLA B27 positive. All other labwork for rheumatic diseases( sedrate, ANA etc) were negative. I had a xray done at that time which showed some inflammation, so he recommended I see a rheumatologist. Being young, I decided not to when the acute exacerbation had died down. I moved out several times for college, each time I saw a new primary care doctor for this problem, they did the same things. Multiple xrays have been done. I do know I have spina bifida occulta at L5, but otherwise the xrays have been fine. No one has recommended an MRI. My question is, do you have to have xray changes to be diagnosed with AS or RA?