Back pain is one of the most common reasons to see a doctor. Chronic back pain can be a symptom of ankylosing spondylitis, a form of arthritis that often starts before age 40.
Spondylitis means inflammation of the spine, and ankylosing means growing together, or fusing. In advanced cases, the vertebrae grow new bone which fuses the spine in a fixed, immobile position. Thus it is important to get early diagnosis and treatment. Unfortunately, diagnosis is typically made five to seven years after the disease process begins. It is a challenge for primary care medicine to identify which patients need a referral to a rheumatologist.
Ankylosing spondylitis generally begins in the age range of 15 to 35 years old, but it can also start in children or older adults. Inflammation affects primarily the back and sacroiliac joint, but it can also spread to other joints and organs, including the eyes and intestines. Pain in the lower back and buttocks are typically the first symptoms. Morning stiffness is common. The symptoms generally improve with exercise. About 75 percent of patients show good or very good response to non-steroidal anti-inflammatory drugs within 48 hours.
Treatment options include the following:
2. Exercise and physical therapy,
3. Good posture practice,
4. Heat/cold to relax muscles and reduce joint pain,
8. Transcutaneous electrical nerve stimulation,
10. Chinese herbal medicine,
11. Surgery, including knee and hip replacement.
Medication includes several different approaches to modifying the inflammatory process. Options include:
1. Non-steroidal anti-inflammatories. These are the old stand-by drugs aspirin, ibuprofen, naproxen, indomethacin, celecoxib, diclofenac, misoprostol, and meloxicam. They inhibit the action of cyclooxygenase (COX) in producing prostaglandins.
2. Corticosteroids. These are the steroidal anti-inflammatories, which are more powerful but also carry higher risks of side effects.
3. Sulfasalazine. This is used for arthritis and inflammatory bowel disease.
4. Methotrexate. Originally developed to treat cancer, this chemotherapy drug is used in smaller doses to treat rheumatoid arthritis and ankylosing spondylitis.
5. Tumor necrosis factor (TNF) inhibitors. These are proteins known as biologic drugs, which must be injected.
The Spondylitis Association of America offers detailed information and news on its web site: Spondylitis.org/.
Kain T et al, “Evidence-based recommendations for the diagnosis of ankylosing spondylitis: results from the Australian 3E initiative in rheumatology”, Med J Aust. 2008 Feb 18; 188(4): 235-7.
TNF inhibitor drugs:
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.