ANKYLOSING SPONDYLITIS
ATTENTION TO LOWER PAIN IN YOUTH!
|
Low back pain is a very common problem all over the world and is seen more frequently over time. At least 10% of the adult population may have chronic low back pain that develops for various reasons. Low back pain is often underestimated because most of it is clinically insignificant and passes in a short time. However, some of these pains are caused by mechanical reasons such as lumbar hernia, compression fractures in the lumbar vertebrae, and some are due to Ankylosing Spondylitis (AS), a type of inflammatory rheumatism that starts especially in young middle ages, and related diseases. In addition, although rare, some types of cancer may present themselves for the first time with low back pain. Again, some infections such as Brucella may present with low back pain. For these reasons, low back pain should be taken seriously and it is necessary to investigate whether there is an underlying disease. |
Here, we will talk about Ankylosing Spondylitis (AS), which is the cause of chronic low back pain that often occurs in young people, and related diseases. AS is a disease that has been noticed frequently in the community in recent years. AS and related diseases are reported to be around 0.1-1% among adults. So, for example, if we assume that there are 100,000 adults in a medium-sized province, we can estimate that there are at least 100 to 1000 AS and related patients.
What Causes This Disease?
The reason is not yet known. However, if one of the parents has this defect, the probability of having children increases. This suggests that it has a genetic aspect. Indeed, a gene called HLAB27 is detected in these patients at least 10 times more often than in healthy people. In addition to the presence of this gene, some microbes that cause intestinal and urinary tract diseases lead to the development of AS and related diseases. Again, psoriasis (Psoriasis), inflammatory bowel diseases (such as Crohn’s, Ulcerative colitis) can cause the emergence of these diseases.
How Does This Disease Start?
The main feature is low back pain, which progresses insidiously between the ages of 20-40. This pain increases after prolonged inactivity. For example, the patient feels worse in the morning, the pain in his back is worse in the morning, starting at midnight. The patient feels better in terms of low back pain when he moves, goes to work or takes a bath with hot water. Low back pain settles in the back and neck over time, restricts the movements of the waist, back and neck, and can cause a hump on the back. These diseases do not only affect the waist. The ankle can also involve many joints, especially joints such as the knee. Involvement of the hip joint may be severe enough to require hip replacement.
In some cases, the disease first begins with an eye disease called uveitis. Therefore, it is imperative that everyone with anterior uveitis should be investigated for AS and related diseases. If people with psoriasis and inflammatory bowel disease also have low back pain, care should be taken in terms of these diseases.
To a lesser extent, it can also cause heart, lung and kidney problems. It can lead to decreased bone density and compression fractures in the vertebrae.
Timely referral to a rheumatologist ensures earlier diagnosis of the disease. Many cases have been treated for years with the diagnosis of herniated disc, and even surgery.
Is There a Difference Between Men and Women?
Some studies have reported that this group of diseases is slightly more common in men. In addition, the disease is generally milder in women. It can be more severe in men than in women and can progress to a heavy hump over time. Severe disease is rarer in women. However, this does not mean that the disease should not be treated in women. Untreated patients may experience many problems, especially deformities in the spine and other joints, and kidney and heart problems.
How is the treatment done?
These diseases are inflammatory diseases initiated by some external factors such as infection in a genetically predisposed individual. Our primary goal is to suppress inflammation. For this, we use various anti-inflammatory drugs such as indomethacin, diclofenac. Apart from this, we give drugs such as methotrexate and sulfasalazine, especially in cases involving joints other than the waist. Again, in cases resistant to exercise and classical drug treatments, drugs in the TNF alpha blocker class have been found to be quite successful in suppressing the disease. Apart from medication, patients should do exercises to strengthen their back muscles. Sports such as swimming and volleyball are very suitable for this. It is recommended that patients do not sleep on their side, lie on their back or prone and lie wide, and because smokers develop more severe signs of disease, they should definitely quit smoking.
As a result, young people with lower back pain, which is more pronounced in the morning, should not delay it and should definitely consult a doctor. Early diagnosis and treatment will minimize joint and lower back damage due to this disease and the resulting disabilities.
