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Posted at: Oct 6, 2018, 12:13 AM; last updated: Oct 6, 2018, 12:13 AM (IST)

Beware of a stiff spine

Ankylosing spondylitis is a disease of the young, as symptoms usually start in the twenties and thirties

Dr Ashit Syngle

Ankylosing spondylitis (AS) is an autoimmune disease characterised by inflammation that mainly affects the spine, the pelvis, hips and shoulders. In India, the prevalence of AS is about 0.1 per cent to 0.2 per cent. It is two to three times more common in men than in women. Although it can affect people of all ages, AS is a disease of the young, because its symptoms are most likely to start developing in the twenties and thirties. It is difficult to diagnose in the early stages and is the most overlooked cause of persistent back pain in young adults. The delay in diagnosis can lead to disability and a reduced capability to work. Even children can develop AS. It is known as ‘juvenile ankylosing spondylitis’.

When AS starts the initial inflammation could be because the body’s immune system is ‘activated’ to fight a bacterial or microbial infection. However, if for some reason the body is unable to ‘turn off’ this activation, it can lead to chronic tissue inflammation even though the bacteria or microbes no longer pose a threat to the body.

Causes

In almost 90 per cent cases, causes are genetic. A person has a higher risk of developing AS if he/she is born with HLA-B27 gene. Those who develop AS, about 90 per cent test positive for this gene. However, not everyone who has the gene develops the condition. In India, about 8 per cent to 10 per cent of people are born with this gene. Other risk factors include a family history of the disease and having frequent gastrointestinal infections. Also men are more prone to it than women

Treatment and prevention

If you suspect that you may be suffering from AS, visit a rheumatologist. The treatment usually involves prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and stiffness in the spine and other joints. Patents are encouraged to exercise regularly and stay active. Those who do not respond to exercise and NSAIDs may also be prescribed drugs known as ‘disease-modifying antirheumatic drugs’ or DMARDs (that are synthetic or biologic). The biologic DMARDs have improved the quality of life and outcomes of this disease for many patients. Many of the biologic DMARDs are available today as self-administrable pre-filled pen or syringes even in India.

It is important to begin specialised treatment as early as possible. Early diagnosis, appropriate specialised treatment and lifestyle modification can help to slow down disease progression and prevent deformity and disability, so patients can lead a healthy and productive life.

Can AS be prevented?

At present there’s no way to prevent this inherited autoimmune disease. Hence, people should be made aware about this disease and encouraged to get an early diagnosis, as controlling and managing the disease is easier. It also helps to avoid related complications such as osteoporosis, vertebrae fusion, uveitis (inflammation in the eye) and lung, heart and kidney disease. AS patients have a higher risk of heart disease, so it is important that they also reduce manageable risk factors such as obesity, high blood pressure, high cholesterol levels and smoking.

Diagnosis

The diagnosis is based on evaluating the patient’s symptoms and doing a physical examination, X-rays and some blood tests. In some cases, advanced tests such as an MRI may be required. 

Symptoms

Characteristic symptoms include low back or buttock pain for over three months which gets worse in the second half of night, early morning stiffness that may last for over an hour and improves with movement and worsens with inactivity. People who are prone will notice these symptoms even before they turn 40.

—The writer is rheumatologist, Fortis Multispecialty Hospital, Mohali

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