Spondyloarthritis – Ankylosing Spondylitis
Spondyloarthritis comprises of a group of conditions where the arthritis occurs in joints of the spine as well as peripheral joints. Patients present with back pain which improves with activity and worsens with rest. They may have swelling, pain and stiffness of other joints. The following conditions are part of the spondyloarthritis spectrum: Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis, Enteropathic Arthritis and Undifferentiated Spondyloarthritis.
Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis affecting the spine
(sacroiliac joints and spine) , peripheral joints, entheses (attachment of tendons to bones) and extra-articular sites such as eyes, heart, lungs and bowel which leads to functional decline and disability. The age of onset is usually second to third decade (before 45 years) and it is more common in men. Patients present with back pain which is worse on rest and improves with activity, early morning stiffness lasting for more than 30 minutes and occasionally pain and swelling of the large joints of limbs. Patients may also present with other symptoms such as red eyes, blood in stools or breathing difficulty. Over time, patients with AS develop reduce movements of cervical and lumbar spine. A strong association with HLAB27 gene is seen in 90% of patients with AS. HLAB27 is present in roughly 6% of the normal population. You should consult a Rheumatologist if you have persistent back pain which is worse in the morning or after periods of rest, reduced mobility of neck and spine, other joint pains or any of the symptoms mentioned above.
Your Rheumatologist will ask you questions about your symptoms examine you and order investigations including blood tests like ESR, CRP and HLAB27 and x-rays of the spine and pelvis to arrive at a diagnosis. Your Rheumatologist will discuss the best available treatment options and expected outcomes with you. Treatment options may include tablets, injectable medications, joint injections, Vitamin D and calcium supplementation, exercises and others. Newer treatment options for AS include TNF-alpha inhibitors like Infliximab and Etanercept which are available in India. You will also need some regular ongoing treatment to control your pain. Learning strategies to cope with your pain, balancing your activities and rest periods and eating a healthy balanced diet are also essential. Feel free to discuss your difficulties with your Rheumatologist and seek help when needed.
Take home message: Inflammatory back pain (pain better with activity and worse after rest like sleeping and early morning stiffness for more than 30 minutes) in a young individual needs assessment by a Rheumatologist if it persists for more than 6 weeks.