Spondyloarthritis consists of a group of conditions in which arthritis occurs in the joints of the spine and peripheral joints. Patients present with low back pain, which improves with activity and worsens with rest. There may be swelling, pain, and stiffness in other joints. The following conditions are part of the spondyloarthritis spectrum: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteric arthritis and undifferentiated spondyloarthritis.
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the spine.
External joints such as the eyes, heart, lungs and intestines (sacroiliac joints and spine), peripheral joints, tendons (attachment of tendons to bone), and dysfunction and disability. The age of onset is usually 2 to 30 years (before 45 years) and is more common in men. Patients show low back pain that worsens at rest and improves with activity, early morning stiffness that lasts more than 30 minutes, and occasionally pain and swelling in the large joints of the limbs. Patients may also have other symptoms such as red eyes, bloody stools, and dyspnea. Over time, patients with AS reduce cervical and lumbar spine movements. 90% of AS patients have a strong association with the HLAB27 gene. HLAB27 is present in about 6% of the normal population. If you have persistent low back pain that worsens in the morning or after rest, decreased neck or spine mobility, other joint pain, or any of the above symptoms, you should consult a rheumatologist.
A rheumatologist will ask you questions about your condition, examine you, and order an investigation that includes blood tests such as ESR, CRP, HLAB27, and spine and pelvic X-rays to make a diagnosis. Your rheumatologist will discuss with you the best treatment options available and the expected outcomes. Treatment options include tablets, injections, joint injections, vitamin D and calcium supplementation, and exercise. New treatment options for AS include TNF-α inhibitors such as infliximab and etanercept available in India. It also requires regular, continuous treatment to control the pain. It is also essential to learn strategies for dealing with pain, balance activity and rest periods, and eat a healthy and balanced diet. Discuss the problem with your rheumatologist and seek help if necessary.
Takeaway Message: Inflammatory low back pain in young individuals (activity improves pain and lasts more than 30 minutes after rest such as sleep or early morning stiffness) is required if the rheumatologist evaluates it for more than 6 weeks.
DR Mannish Dugar
MD, FRACP (Australia)
Apollo Hospital in Hyderabad