Keep track of your back

Back pain is a common complaint that most of us have. Virtually all adults would have experienced back pain at some point of their life time. But one should be aware that back pain can also be signal of a condition called ankylosing spondylitis (AS).

AS is a disorder that is often misunderstood as back pain - related to ageing. It is basically an inflammatory condition that affects the joints of the spine, reducing flexibility, damaging the posture and posing the risk of loss of mobility. AS strikes youngsters, predominantly men in their productive years. The demand for high physical activity and the stresses of life worsen the pain.

There has been an alarming increase in the incidence of AS, among Indians who are in their late 20s and early 30s. It affects 1 in every 100 people, and is particularly prevalent in men. A family history of AS is an additional risk factor.

The condition often surfaces as chronic pain, especially in the back and shows no sign of being an autoimmune disease. Constant pain impacts efficiency, gradually gives rise to psychological issues, which further affect the quality of life.

Identifying AS

AS often manifests first as pain in the hip and lower back. The first joints affected are usually the sacroiliac (SI) joints, which join the base of the spine to the pelvis. But lower back pain is a nonspecific symptom, caused by many spinal conditions. People with AS may also report the following pain-related symptoms:

* The initial symptoms should be as subtle as stiff back when they wake up early morning or when they sit for prolonged period. The pain is usually in the lower back and often entire back may be painful.

* The neck may be in pain or stiff. The patient might experience difficulty in turning the head, making certain activities, such as driving, more challenging. While anyone with AS can experience neck pain, women tend to report it more frequently than men.

* About half of the AS patients develop inflammation of joints in the arms and legs. Peripheral pain and stiffness is most commonly experienced in the knees, shoulders, ankles, Achilles tendon, plantar fascia (causing pain at the bottom of the heel).

* Children with AS often report pain in their heels and/or knees, not the lower back.

* Unlike back pain from other causes, pain induced by AS worsens during periods of rest or inactivity. Exercise typically helps to reduce pain.

* Often mistaken for common backache, any pain or stiffness which lasts for more than 30 minutes in the morning is a warning sign of AS. Affected joints may feel stiff after getting out of bed, and may improve with movement or a warm shower.

* Many people report that pain wakes them up, often in the second half of the night.

* Several AS patients report tenderness over the area of inflammation. For example, pressing the skin over the base of the spine may be uncomfortable or painful.

* Almost everyone with AS reports experiencing painful flares - periods of time when symptoms are noticeably worse. Flares can occur suddenly and cause pain and stiffness all over the body. Flares may last days or weeks and are followed by periods of relative relief.

* Almost 30% to 40% of people with AS experience an inflammatory eye condition called uveitis. Uveitis, sometimes called iritis, can cause redness, discomfort, sensitivity to light, and impaired vision.

Treatment & management

AS is a manageable disease. The disease is characterised by exacerbation and remission. The disease when active progressively causes damages to the spine and produces fusion and irreversible damage. The primary objective of the cure is to reduce the pain and discomfort, and the additional intention is to avoid deformity and disability. The initial evaluation of the disease includes through physical examination, X-Ray, MRI and a series of blood tests.

Lifestyle modification is the first step to improve the disease. Regular exercise is prescribed to reduce pain and deformities. Swimming, yoga and other back stretching activities help.

Several treatment options like painkillers, anti-inflammatory drugs and disease modifying anti-rheumatic drugs are prescribed to ease pain and stiffness. Modern medicines like biologics, which are now available in India, have shown significant improvement in slowing down the disease progression and improving quality of life of AS patients.

(The author is rheumatologist, ChanRe Rheumatology & Immunology Centre & Research)