8 things you may not know about ankylosing spondylitis (AS): an overlooked cause of back pain

Dr. Pravin Patil
Friday, 8 June 2018

‘Spondylosis’ must not be confused with ankylosing spondylitis

AS is a type of arthritis that mainly affects the spine
As the name suggests, the word ‘ankylosing spondylitis’ (AS) has two parts to it. Ankylosing (Ankylosis) refers to fusion of bones. In AS, the bones of the spine (vertebrae) fuse together, resulting in a rigid bamboo-like spine. Spondylitis is a rather broad term and it refers to the redness and swelling (inflammation) in the joints of spine. 

Do note: ‘spondylosis’ must not be confused with AS. It is a different term used to described wear and tear in the spine.  
AS often remains misdiagnosed as ‘simple’ back pain for years
In the early stages, the symptoms of AS are similar to common back problems. Because of this, many people try to handle the pain for some time before visiting the doctor. The average individual has very little knowledge of rheumatic diseases such as AS. The reality in India is that a majority of people are unaware of what ‘rheumatology’ is all about.
The main symptom is pain in the lower back
Patients may have pain over the buttocks and in the back of their thighs. The buttock pain may be felt sometimes on one side and sometimes on the other side. In fact, the pain may wake up a patient from sleep. The pain tends to be worse first thing in the morning but eases as the day goes on. Physical rest does not make it better. Instead, exercise and movement usually ease the pain.
AS is a disease of young people
AS most commonly begins between 15 and 25 years of age, but sometimes it occurs in children and older adults as well. It is three times more common in men than in women. People with a family history of AS are more likely to develop AS – in many affected families, there are two or more members living with AS. It affects about 1 to 2 in 1000 of the adult population.
A variety of treatments options are available
It is managed through a combination of pain relief, exercises and disease modifying drugs. Modern treatment aims at stopping the disease progression, easing the pain and stiffness, keeping the spine mobile and helping the patient live a normal life. A rheumatologist is an expert in this disease and should be consulted early in the course of the illness. 
It is a misconception that allopathy doctors only prescribe steroids and painkillers
Rheumatologists prescribe disease-modifying medications to help with symptoms and stop progression of disease. Newer therapies (Biologics) used by the rheumatologist can slow and in many cases, stop disease progression.
There have been significant advances in treating AS
The most important advance has been the development of a group of drugs called biologics. This group of medications are called biologics because they are derived from living organisms or produced by biotechnology methods. They differ significantly from traditional drugs used to treat RA. Biological drugs target specific components of the immune system instead of broadly affecting many areas of the immune system. Some biological therapies are called anti-TNF drugs. These drugs target a protein known as Tumour Necrosis Factor (TNF). In excess amounts, TNF increases inflammation in the body. Different proteins are targeted by other biological therapies. 

There are many misconceptions about this illness
Some people claim to have been cured by treatment with herbs, oils, special diets or exercise alone. However, there is no scientific evidence that such treatment can cure arthritis such as AS. Importantly, these unregulated treatment modalities may cause serious side effects. Also, delayed treatment can cause irreversible joint damage. The two most important changes you can make is to start exercising and to stop smoking. Taking professional advice for a specific excise regimen is important.  There is little proof that changing your diet can help.

(The writer is a consultanting Rheumatologist)

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